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The value of the ESC guidelines for refining stroke risk stratification in patients with atrial fibrillation categorised as 'low risk' using the ATRIA stroke score: a nationwide cohort study.
Chest. 2014 Jun 19;
Authors: Lip GY, Nielsen PB, Skjøth F, Lane DA, Rasmussen LH, Larsen TB
Abstract
ABSTRACT: BackgroundOur objective was to determine stroke and thromboembolism event rates in patients with atrial fibrillation (AF) classified as 'low risk' using the ATRIA score, and to ascertain event rates in this group in relation to the stroke risk assessment advocated in the 2012 European Society of Cardiology (ESC) guidelines (based on the CHA2DS2-VASc score). We tested the hypothesis that the stroke risk assessment scheme advocated in the ESC guidelines would be able to further refine stroke risk stratification in the 'low risk' category defined by the ATRIA score. Methods and ResultsIn our cohort of 207,543 incident AF patients from 1999-2012, we identified 72,452 subjects who had an ATRIA score of 0-5 ('low risk').Even amongst these patients categorised as 'low risk' using the ATRIA score, the 1 year stroke/thromboembolic event rate ranged from 1.13 to 36.94 per 100 person-years, when subdivided by CHA2DS2-VASc scores.In patients with an ATRIA score 0-5, c-statistics at 1 year follow up in the Cox regression model were significantly improved from 0.626 (95% CI 0.612-0.640) to 0.665 (95% CI 0.651-0.679) when the CHA2DS2-VASc score was used for categorising stroke risk instead of the ATRIA score (p<0.001). ConclusionPatients categorised as 'low risk' using an ATRIA score 0-5 are not necessarily 'low risk', with 1 year event rates as high as 36.94 per 100 person-years. Thus, the stroke risk stratification scheme recommended in the ESC guidelines (based on the CHA2DS2-VASc score) would be best at identifying the 'truly low risk' AF subjects who do not need any antithrombotic therapy.
Background: Our objective was to determine stroke and thromboembolism event rates in patients with atrial fibrillation (AF) classified as 'low risk' using the ATRIA score, and to ascertain event rates in this group in relation to the stroke risk assessment advocated in the 2012 European Society of Cardiology (ESC) guidelines (based on the CHA2DS2-VASc score). We tested the hypothesis that the stroke risk assessment scheme advocated in the ESC guidelines would be able to further refine stroke risk stratification in the 'low risk' category defined by the ATRIA score.
Methods and Results: In our cohort of 207,543 incident AF patients from 1999-2012, we identified 72,452 subjects who had an ATRIA score of 0-5 ('low risk'). Even amongst these patients categorised as 'low risk' using the ATRIA score, the 1 year stroke/thromboembolic event rate ranged from 1.13 to 36.94 per 100 person-years, when subdivided by CHA2DS2-VASc scores. In patients with an ATRIA score 0-5, c-statistics at 1 year follow up in the Cox regression model were significantly improved from 0.626 (95% CI 0.612-0.640) to 0.665 (95% CI 0.651-0.679) when the CHA2DS2-VASc score was used for categorising stroke risk instead of the ATRIA score (p<0.001).
Conclusion: Patients categorised as 'low risk' using an ATRIA score 0-5 are not necessarily 'low risk', with 1 year event rates as high as 36.94 per 100 person-years. Thus, the stroke risk stratification scheme recommended in the ESC guidelines (based on the CHA2DS2-VASc score) would be best at identifying the 'truly low risk' AF subjects who do not need any antithrombotic therapy.
PMID: 25086251 [PubMed - as supplied by publisher]