Thromb Haemost 2018; 118(12): 2162-2170
DOI: 10.1055/s-0038-1675401
Stroke, Systemic or Venous Thromboembolism
Georg Thieme Verlag KG Stuttgart · New York

Should the Presence or Extent of Coronary Artery Disease be Quantified in the CHA2DS2-VASc Score in Atrial Fibrillation? A Report from the Western Denmark Heart Registry

Kamilla Steensig*
1  Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
,
Kevin K. W. Olesen*
1  Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
2  Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
,
Troels Thim
1  Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
,
Jens C. Nielsen
1  Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
,
Svend E. Jensen
3  Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
,
Lisette O. Jensen
4  Department of Cardiology, Odense University Hospital, Odense, Denmark
,
Steen D. Kristensen
1  Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
,
Hans Erik Bøtker
1  Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
,
Gregory Y. H. Lip**
5  Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
6  Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, University of Liverpool, Liverpool, United Kingdom
7  Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
,
Michael Maeng**
1  Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
› Author Affiliations
Funding This work was funded by the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark.
Further Information

Publication History

28 September 2018

06 October 2018

Publication Date:
12 November 2018 (eFirst)

Abstract

Background Patients with atrial fibrillation (AF) have an increased risk of ischaemic stroke. The risk can be predicted by the CHA2DS2-VASc score, in which the vascular component refers to previous myocardial infarction, peripheral artery disease and aortic plaque, whereas coronary artery disease (CAD) is not included.

Objectives This article explores whether CAD per se or extent provides independent prognostic information of future stroke among patients with AF.

Materials and Methods Consecutive patients with AF and coronary angiography performed between 2004 and 2012 were included. The endpoint was a composite of ischaemic stroke, transient ischaemic attack and systemic embolism. The risk of ischaemic events was estimated according to the presence and extent of CAD. Incidence rate ratios (IRR) were calculated in reference to patients without CAD and adjusted for parameters included in the CHA2DS2-VASc score and treatment with anti-platelet agents and/or oral anticoagulants.

Results Of 96,430 patients undergoing coronary angiography, 12,690 had AF. Among patients with AF, 7,533 (59.4%) had CAD. Mean follow-up was 3 years. While presence of CAD was an independent risk factor for the composite endpoint (adjusted IRR, 1.25; 1.06–1.47), extent of CAD defined as 1-, 2-, 3- or diffuse vessel disease did not add additional independent risk information.

Conclusion Presence, but not extent, of CAD was an independent risk factor of the composite thromboembolic endpoint beyond the components already included in the CHA2DS2-VASc score. Consequently, we suggest that significant angiographically proven CAD should be included in the vascular disease criterion in the CHA2DS2-VASc score.

* Kamilla Steensig and Kevin K. W. Olesen are first co-authors.