Atrial high-rate episodes intensify R2CHA2DS2-VASc score for prognostic stratification in pacemaker patients
Abstract Patients with device detected atrial high-rate episodes (AHRE) have an increased risk of MACE. The R2CHA2DS2-VASc, CHADS2, R2CHADS2 and CHA2DS2-VASc score have been investigated for predicting major adverse cardiovascular events (MACE) in different groups of patients. We aimed to evaluate t...
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Nature Portfolio
2023-05-01
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| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-023-34784-7 |
| _version_ | 1797827484136243200 |
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| author | Yi-Pan Li Ju-Yi Chen Tse-Wei Chen Wei-Da Lu |
| author_facet | Yi-Pan Li Ju-Yi Chen Tse-Wei Chen Wei-Da Lu |
| author_sort | Yi-Pan Li |
| collection | DOAJ |
| description | Abstract Patients with device detected atrial high-rate episodes (AHRE) have an increased risk of MACE. The R2CHA2DS2-VASc, CHADS2, R2CHADS2 and CHA2DS2-VASc score have been investigated for predicting major adverse cardiovascular events (MACE) in different groups of patients. We aimed to evaluate the R2CHA2DS2-VASc score in combination with AHRE ≥ 6 min for predicting MACE in patients with dual-chamber PPM but no prior atrial fibrillation (AF). We retrospectively enrolled 376 consecutive patients undergoing dual-chamber PPM implantation and no prior AF. The primary endpoint was subsequent MACE. For all patients in the cohort, CHADS2, R2CHADS2, CHA2DS2-VASc, R2CHA2DS2-VASc scores and AHRE ≥ or < 6 min were determined. AHRE was recorded as a heart rate > 175 bpm (Medtronic) or > 200 bpm (Biotronik) lasting ≥ 30 s. Multivariate Cox regression analysis with time-dependent covariates was used to determine the independent predictors of MACE. ROC-AUC analysis was performed for CHADS2, R2CHADS2, CHA2DS2-VASc, and R2CHA2DS2-VASc scores and then adding AHRE ≥ 6 min to the four scores. The median age was 77 years, and 107 patients (28.5%) developed AHRE ≥ 6 min. After a median follow-up of 32 months, 46 (12.2%) MACE occurred. Multivariate Cox regression analysis showed that R2CHA2DS2-VASc score (HR, 1.485; 95% CI, 1.212–1.818; p < 0.001) and AHRE ≥ 6 min (HR, 2.125; 95% CI, 1.162–3.887; p = 0.014) were independent predictors for MACE. The optimal R2CHA2DS2-VASc score cutoff value was 4.5 (set at ≥ 5), with the highest Youden index (AUC, 0.770; 95% CI, 0.709–0.831; p < 0.001). ROC-AUC analysis of the four risk scores separately combined with AHRE ≥ 6 min all showed better discriminatory power than the four scores alone (All Z-statistic p < 0.05). In patients with PPM who develop AHRE ≥ 6 min, it is crucial to perform risk assessment with either four scores to further stratify risk for MACE. |
| first_indexed | 2024-04-09T12:50:06Z |
| format | Article |
| id | doaj.art-066b8c0771624e1f998b52d82efc9dcf |
| institution | Directory Open Access Journal |
| issn | 2045-2322 |
| language | English |
| last_indexed | 2024-04-09T12:50:06Z |
| publishDate | 2023-05-01 |
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| spelling | doaj.art-066b8c0771624e1f998b52d82efc9dcf2023-05-14T11:16:16ZengNature PortfolioScientific Reports2045-23222023-05-0113111210.1038/s41598-023-34784-7Atrial high-rate episodes intensify R2CHA2DS2-VASc score for prognostic stratification in pacemaker patientsYi-Pan Li0Ju-Yi Chen1Tse-Wei Chen2Wei-Da Lu3Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityDivision of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityDivision of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityDivision of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityAbstract Patients with device detected atrial high-rate episodes (AHRE) have an increased risk of MACE. The R2CHA2DS2-VASc, CHADS2, R2CHADS2 and CHA2DS2-VASc score have been investigated for predicting major adverse cardiovascular events (MACE) in different groups of patients. We aimed to evaluate the R2CHA2DS2-VASc score in combination with AHRE ≥ 6 min for predicting MACE in patients with dual-chamber PPM but no prior atrial fibrillation (AF). We retrospectively enrolled 376 consecutive patients undergoing dual-chamber PPM implantation and no prior AF. The primary endpoint was subsequent MACE. For all patients in the cohort, CHADS2, R2CHADS2, CHA2DS2-VASc, R2CHA2DS2-VASc scores and AHRE ≥ or < 6 min were determined. AHRE was recorded as a heart rate > 175 bpm (Medtronic) or > 200 bpm (Biotronik) lasting ≥ 30 s. Multivariate Cox regression analysis with time-dependent covariates was used to determine the independent predictors of MACE. ROC-AUC analysis was performed for CHADS2, R2CHADS2, CHA2DS2-VASc, and R2CHA2DS2-VASc scores and then adding AHRE ≥ 6 min to the four scores. The median age was 77 years, and 107 patients (28.5%) developed AHRE ≥ 6 min. After a median follow-up of 32 months, 46 (12.2%) MACE occurred. Multivariate Cox regression analysis showed that R2CHA2DS2-VASc score (HR, 1.485; 95% CI, 1.212–1.818; p < 0.001) and AHRE ≥ 6 min (HR, 2.125; 95% CI, 1.162–3.887; p = 0.014) were independent predictors for MACE. The optimal R2CHA2DS2-VASc score cutoff value was 4.5 (set at ≥ 5), with the highest Youden index (AUC, 0.770; 95% CI, 0.709–0.831; p < 0.001). ROC-AUC analysis of the four risk scores separately combined with AHRE ≥ 6 min all showed better discriminatory power than the four scores alone (All Z-statistic p < 0.05). In patients with PPM who develop AHRE ≥ 6 min, it is crucial to perform risk assessment with either four scores to further stratify risk for MACE.https://doi.org/10.1038/s41598-023-34784-7 |
| spellingShingle | Yi-Pan Li Ju-Yi Chen Tse-Wei Chen Wei-Da Lu Atrial high-rate episodes intensify R2CHA2DS2-VASc score for prognostic stratification in pacemaker patients Scientific Reports |
| title | Atrial high-rate episodes intensify R2CHA2DS2-VASc score for prognostic stratification in pacemaker patients |
| title_full | Atrial high-rate episodes intensify R2CHA2DS2-VASc score for prognostic stratification in pacemaker patients |
| title_fullStr | Atrial high-rate episodes intensify R2CHA2DS2-VASc score for prognostic stratification in pacemaker patients |
| title_full_unstemmed | Atrial high-rate episodes intensify R2CHA2DS2-VASc score for prognostic stratification in pacemaker patients |
| title_short | Atrial high-rate episodes intensify R2CHA2DS2-VASc score for prognostic stratification in pacemaker patients |
| title_sort | atrial high rate episodes intensify r2cha2ds2 vasc score for prognostic stratification in pacemaker patients |
| url | https://doi.org/10.1038/s41598-023-34784-7 |
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