Applying the CHA2DS2-VASc score to predict the risk of future acute coronary syndrome in patients receiving catheter ablation for atrial fibrillation

Ching-Yao Chou; Yun-Yu Chen; Yenn-Jiang Lin; Kuo-Liong Chien; Shih-Lin Chang; Ta-Chuan Tuan; Li-Wei Lo; Tze-Fan Chao; Yu-Feng Hu; Fa-Po Chung; Jo-Nan Liao; Chin-Yu Lin; Ting-Yung Chang; Shih-Ann Chen

doi:10.1016/j.ijcha.2020.100567

Applying the CHA₂DS₂-VASc score to predict the risk of future acute coronary syndrome in patients receiving catheter ablation for atrial fibrillation

Int J Cardiol Heart Vasc. 2020 Jun 28:29:100567. doi: 10.1016/j.ijcha.2020.100567. eCollection 2020 Aug.

Authors

Ching-Yao Chou^{1

2

3}, Yun-Yu Chen^{1

4}, Yenn-Jiang Lin^{1

2}, Kuo-Liong Chien⁴, Shih-Lin Chang^{1

2}, Ta-Chuan Tuan^{1

2}, Li-Wei Lo^{1

2}, Tze-Fan Chao^{1

2}, Yu-Feng Hu^{1

2}, Fa-Po Chung^{1

2}, Jo-Nan Liao^{1

2}, Chin-Yu Lin^{1

2}, Ting-Yung Chang^{1

2}, Shih-Ann Chen^{1

2}

Affiliations

¹ Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
² School of Medicine, Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.
³ Division of Cardiology, Medical Center, Shin Kong Wu Ho Su Memorial Hospital, Taipei, Taiwan.
⁴ Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University, Taipei, Taiwan.

Abstract

Objective: It remains unknown whether catheter ablation for atrial fibrillation (AF) reduces future acute coronary syndrome (ACS) risk or whether the CHA₂DS₂-VASc score has a role in predicting this risk. We aimed to compare very long-term risk of ACS between patients who received catheter ablation to AF or antiarrhythmic medications and controls without AF.

Methods: Propensity scores were calculated for each patient and used to assemble a cohort of 787 patients undergoing AF ablation in 2003-2012. Patients were compared to an equal number of AF patients treated with antiarrhythmic medications and a control group without AF. Patients with previous coronary events were excluded. The primary endpoint was ACS occurrence.

Results: Baseline clinical characteristics were comparable. After a mean 9.1 ± 3.2-year follow-up, the ablation group had lower incidence of new onset ACS than the medication and non-AF control groups (annual incidence: 0.15%. 0.78%, and 0.35%; with 2.67, 4.16, and 10.44 cases/1000 person-years, respectively; P < 0.001). After adjusting for multiple confounders, the ablation group had lower future ACS risk than the medication (hazard ratio [HR]: 0.20, 95% confidence interval [CI]: 0.13-0.30) and control groups (HR: 0.30, 95% CI: 0.20-0.45). The CHA₂DS₂-VASc score was a strong predictor of ACS (HR: 1.61, 95% CI: 1.47-1.76; AUC: 85.9%, 95% CI: 78.5-93.2%). A baseline CHA₂DS₂-VASc score ≥ 4 predicted future ACS (positive predictive rate: 14.3%).

Conclusions: This study suggested that catheter ablation for AF may be beneficial to reduce future ACS risk in AF patients, and a high baseline CHA₂DS₂-VASc score can predict future acute coronary events.

Keywords: Acute coronary syndrome; Atrial fibrillation; CHA2DS2-VASc score.