Association of CHA2DS2-VASc Score with Long-Term Incidence of New-Onset Atrial Fibrillation and Ischemic Stroke after Myocardial Infarction
The CHA<sub>2</sub>DS<sub>2</sub>-VASc score is a reliable tool used to estimate the risk of ischemic stroke (IS) in patients with atrial fibrillation (AF). Few tools exist for the prediction of new-onset AF (NOAF) after myocardial infarction (MI) and its relation to IS. We s...
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MDPI AG
2022-11-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/23/7090 |
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| author | Samuli Jaakkola Tuomas Paana Juhani Airaksinen Jussi Sipilä Ville Kytö |
| author_facet | Samuli Jaakkola Tuomas Paana Juhani Airaksinen Jussi Sipilä Ville Kytö |
| author_sort | Samuli Jaakkola |
| collection | DOAJ |
| description | The CHA<sub>2</sub>DS<sub>2</sub>-VASc score is a reliable tool used to estimate the risk of ischemic stroke (IS) in patients with atrial fibrillation (AF). Few tools exist for the prediction of new-onset AF (NOAF) after myocardial infarction (MI) and its relation to IS. We studied the usefulness of CHA<sub>2</sub>DS<sub>2</sub>-VASc in predicting NOAF and IS in a long-term follow-up after MI. Consecutive MI patients without baseline AF (<i>n</i> = 70,922; mean age: 68.2 years), discharged from 20 hospitals in Finland during 2005–2018, were retrospectively studied using national registries. The outcomes of interest after discharge were NOAF- and IS-assessed with competing risk analyses at one and ten years. The median follow-up was 4.2 years. The median baseline CHA<sub>2</sub>DS<sub>2</sub>-VASc score was 3 (IQR 2–5). The likelihood of both NOAF and NOAF-related IS increased stepwise with this score at one and ten years (all <i>p</i> < 0.0001). The one-year-adjusted subdistribution hazard ratio (sHR) was 4.03 (CI 3.68–4.42) for NOAF in patients with CHA<sub>2</sub>DS<sub>2</sub>-VASc scores ≥6 points. The cumulative incidence of IS was 15.2% in patients with NOAF vs. 6.2% in patients without AF at 10 years after MI (adj. sHR 2.12; CI 1.98–2.28; <i>p</i> < 0.0001). Coronary artery bypass surgery was associated with a higher NOAF incidence compared to percutaneous coronary intervention (adj. sHR 1.87; CI 1.65–2.13; <i>p</i> < 0.0001 one year after MI). The CHA<sub>2</sub>DS<sub>2</sub>-VASc score is a simple tool used to estimate the long-term risk of NOAF and IS after MI in patients without baseline AF. Coronary bypass surgery is associated with an increased NOAF incidence after MI. |
| first_indexed | 2024-03-09T17:44:01Z |
| format | Article |
| id | doaj.art-e648ab10cde44c65bcfe938a01de9bb3 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T17:44:01Z |
| publishDate | 2022-11-01 |
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| spelling | doaj.art-e648ab10cde44c65bcfe938a01de9bb32023-11-24T11:22:45ZengMDPI AGJournal of Clinical Medicine2077-03832022-11-011123709010.3390/jcm11237090Association of CHA2DS2-VASc Score with Long-Term Incidence of New-Onset Atrial Fibrillation and Ischemic Stroke after Myocardial InfarctionSamuli Jaakkola0Tuomas Paana1Juhani Airaksinen2Jussi Sipilä3Ville Kytö4Heart Center, Turku University Hospital, University of Turku, 20521 Turku, FinlandHeart Center, Turku University Hospital, University of Turku, 20521 Turku, FinlandHeart Center, Turku University Hospital, University of Turku, 20521 Turku, FinlandDepartment of Neurology, Siun Sote, North Karelia Central Hospital, 80210 Joensuu, FinlandHeart Center, Turku University Hospital, University of Turku, 20521 Turku, FinlandThe CHA<sub>2</sub>DS<sub>2</sub>-VASc score is a reliable tool used to estimate the risk of ischemic stroke (IS) in patients with atrial fibrillation (AF). Few tools exist for the prediction of new-onset AF (NOAF) after myocardial infarction (MI) and its relation to IS. We studied the usefulness of CHA<sub>2</sub>DS<sub>2</sub>-VASc in predicting NOAF and IS in a long-term follow-up after MI. Consecutive MI patients without baseline AF (<i>n</i> = 70,922; mean age: 68.2 years), discharged from 20 hospitals in Finland during 2005–2018, were retrospectively studied using national registries. The outcomes of interest after discharge were NOAF- and IS-assessed with competing risk analyses at one and ten years. The median follow-up was 4.2 years. The median baseline CHA<sub>2</sub>DS<sub>2</sub>-VASc score was 3 (IQR 2–5). The likelihood of both NOAF and NOAF-related IS increased stepwise with this score at one and ten years (all <i>p</i> < 0.0001). The one-year-adjusted subdistribution hazard ratio (sHR) was 4.03 (CI 3.68–4.42) for NOAF in patients with CHA<sub>2</sub>DS<sub>2</sub>-VASc scores ≥6 points. The cumulative incidence of IS was 15.2% in patients with NOAF vs. 6.2% in patients without AF at 10 years after MI (adj. sHR 2.12; CI 1.98–2.28; <i>p</i> < 0.0001). Coronary artery bypass surgery was associated with a higher NOAF incidence compared to percutaneous coronary intervention (adj. sHR 1.87; CI 1.65–2.13; <i>p</i> < 0.0001 one year after MI). The CHA<sub>2</sub>DS<sub>2</sub>-VASc score is a simple tool used to estimate the long-term risk of NOAF and IS after MI in patients without baseline AF. Coronary bypass surgery is associated with an increased NOAF incidence after MI.https://www.mdpi.com/2077-0383/11/23/7090myocardial infarctionatrial fibrillationischemic strokecha2ds2-vasc |
| spellingShingle | Samuli Jaakkola Tuomas Paana Juhani Airaksinen Jussi Sipilä Ville Kytö Association of CHA2DS2-VASc Score with Long-Term Incidence of New-Onset Atrial Fibrillation and Ischemic Stroke after Myocardial Infarction Journal of Clinical Medicine myocardial infarction atrial fibrillation ischemic stroke cha2ds2-vasc |
| title | Association of CHA2DS2-VASc Score with Long-Term Incidence of New-Onset Atrial Fibrillation and Ischemic Stroke after Myocardial Infarction |
| title_full | Association of CHA2DS2-VASc Score with Long-Term Incidence of New-Onset Atrial Fibrillation and Ischemic Stroke after Myocardial Infarction |
| title_fullStr | Association of CHA2DS2-VASc Score with Long-Term Incidence of New-Onset Atrial Fibrillation and Ischemic Stroke after Myocardial Infarction |
| title_full_unstemmed | Association of CHA2DS2-VASc Score with Long-Term Incidence of New-Onset Atrial Fibrillation and Ischemic Stroke after Myocardial Infarction |
| title_short | Association of CHA2DS2-VASc Score with Long-Term Incidence of New-Onset Atrial Fibrillation and Ischemic Stroke after Myocardial Infarction |
| title_sort | association of cha2ds2 vasc score with long term incidence of new onset atrial fibrillation and ischemic stroke after myocardial infarction |
| topic | myocardial infarction atrial fibrillation ischemic stroke cha2ds2-vasc |
| url | https://www.mdpi.com/2077-0383/11/23/7090 |
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