Abstract 10999: CHADS2 and CHA2DS2-VASc scores are Predictive of Adverse Cardiovascular Outcomes in All Patients, Not Just Those With a Diagnosis of AF: an Analysis of the 2010 Patients From the MOST Trial
Currently, CHADS2 and CHA2DS2-VASc scores (C-scores) are tallied only for patients (pts) who already have a diagnosis of atrial fibrillation (AF). We hypothesized that these scores are predictive of adverse cardiovascular events, in all pts, even in the absence of AF.
Methods: We calculated C-scores for the 2010 pts (sick sinus syndrome scheduled for pacemaker implantation) enrolled in the MOde Selection Trial. We evaluated the association of C-scores with the endpoints of the composite of death or stroke (trial primary endpoint), stroke, and death in all pts, and determined whether these associations differed by history of AF.
Results: Fourteen percent of pts had CHADS2 score=0, 27% score=1, 27% score=2, and 32% score ≥3 (the distribution of pts in CHA2DS2-VASc categories was similar); 42% had a history of AF. Both C-scores were associated with the composite of death or stroke (hazard ratio [95% confidence interval] (HR[CI])= 1.11 [1.02-1.21] for each 1-point increase in CHADS2, p=0.016; HR[CI] = 1.14 [1.05-1.23] for each 1-point increase in CHA2DS2-VASc, p=0.0010) (Figure). Hazard ratios for the association of scores with stroke were 1.23 (0.93, 1.63) and 1.16 (0.99, 1.37) for each 1-point increase but were not statistically significant, possibly due to low event rates. CHA2DS2-VASc was also associated with death (HR[CI] = 1.10 [1.01-1.19] for each 1-point increase, p=0.032). Association of C-scores with outcome was not different for patients with history of AF than for patients with no AF history (interaction p-value ≥0.30 for all endpoints for CHADS2 and ≥0.55 for all endpoints for CHA2DS2-VASc).
Conclusion: C-scores predict risk of death or stroke in all pts, regardless of AF history. C-scores could be risk stratification tools for clinical events that might respond to anticoagulation or other interventions, even in the absence of known AF. Further investigation is required to test this strategy for identifying high-risk patients in non-pacemaker populations.
- © 2013 by American Heart Association, Inc.