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.

BACKGROUND

Patients with atrial fibrillation (AF) have an increased risk of ischaemic stroke. The risk can be predicted by the CHADS-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 CHADS-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 CHADS-VASc score. Consequently, we suggest that significant angiographically proven CAD should be included in the vascular disease criterion in the CHADS-VASc score.