Abstract
Background
A new risk model, the R2CHADS2 (Renal Dysfunction, Congestive Heart Failure, Hypertension, Age, Diabetes, Stroke/Transient
Ischemic Attack) score, was proposed to be a powerful scoring scheme in predicting
stroke or systemic embolism in atrial fibrillation (AF). The goal of the present study
is to validate the usefulness of the R2CHADS2 score among patients with AF after catheter ablation. We also aimed to compare the
accuracy of the CHA2DS2-VASc (Congestive Heart Failure, Hypertension, Age [≥ 75 y], Diabetes, Stroke/Transient Ischemic Attack, Vascular Disease, Age [65-74 y], Sex [Female]) and R2CHADS2 scores for risk stratification of thromboembolic (TE) events after ablation procedures.
Methods
We enrolled a total of 526 patients with AF who underwent catheter ablation. The clinical
end point was the occurrence of TE events (ischemic stroke, transient ischemic attack,
or other systemic embolisms) during the postablation follow-up.
Results
During a follow-up of 37.5 ± 21.3 months, 14 patients (2.7%) experienced TE events.
The R2CHADS2 score was an independent predictor of TE events in the multivariate analysis. Patients
with an R2CHADS2 score of > 2 had a higher event rate compared with those with a score of 0 or 1 (0.5% vs 7.7%).
The areas under the receiver operating characteristic (ROC) curves of CHA2DS2-VASc and R2CHADS2 scores in predicting TE events were 0.832 and 0.872, respectively. The difference
between these 2 curves did not reach statistical significance (P = 0.338). In addition, the R2CHADS2 score did not improve net stroke risk reclassification over the CHA2DS2-VASc score (net reclassification improvement, −0.9%; P = 0.948).
Conclusions
The R2CHADS2 and CHA2DS2-VASc scores could be used to predict TE events for patients with AF undergoing catheter
ablation. The predictive accuracy of both scores were similar in this relatively small
cohort undergoing ablation.
Résumé
Introduction
Un nouveau modèle de risque, le score R2CHADS2 (Renal Dysfunction, Congestive Heart Failure, Hypertension, Age, Diabetes, Stroke/Transient
Ischemic Attack, soit la dysfonction rénal, l’insuffisance cardiaque congestive, l’hypertension,
l’âge, le diabète, l’accident vasculaire cérébral et l’ischémie cérébrale transitoire)
a été proposé comme grille de scores efficace pour prédire l’accident vasculaire cérébral
ou l’embolie systémique lors de fibrillation auriculaire (FA). Le but de la présente
étude est de valider l’utilité du score R2CHADS2 chez les patients ayant une FA après l’ablation par cathéter. Nous avons également
pour but de comparer la précision des scores CHA2DS2-VASc (Congestive Heart Failure, Hypertension, Age [≥ 75 y], Diabetes, Stroke/Transient
Ischemic Attack, Vascular Disease, Age [65-74 y], Sex [Female], soit l’insuffisance
cardiaque congestive, l’hypertension, l’âge [≥ 75 ans], le diabète, l’accident vasculaire
cérébral et l’ischémie cérébrale transitoire, la maladie vasculaire, l’âge [65-74
ans], le sexe [féminin]) et R2CHADS2 quant à la stratification du risque d’événements thromboemboliques (ET) après les
procédés d’ablation.
Méthodes
Nous avons inscrit un total de 526 patients atteints de FA qui ont subi une ablation
par cathéter. Le critère de jugement clinique était la survenue d’ET (accident vasculaire
cérébral ischémique, ischémie cérébrale transitoire ou autres embolies systémiques)
durant le suivi après l’ablation.
Résultats
Durant un suivi de 37,5 ± 21,3 mois, 14 patients (2,7 %) ont subi des ET. Le score
R2CHADS2 a été un prédicteur indépendant d’ET dans l’analyse multivariée. Les patients ayant
un score R2CHADS2 > 2 ont eu un taux d’événement plus élevé comparativement à ceux ayant un score de
0 ou de 1 (0,5 % vs 7,7 %). Les surfaces sous les courbes caractéristiques d’efficacité du récepteur
(ROC : receiver operating characteristic) des scores CHA2DS2-VASc et R2CHADS2 pour prédire les ET ont respectivement été de 0,832 et de 0,872. La différence entre
ces 2 courbes n’a pas suffisamment été marquée pour être statistiquement significative
(P = 0,338). De plus, le score R2CHADS2 n’a pas amélioré la reclassification nette du risque d’accident vasculaire cérébral
par rapport au score CHA2DS2-VASc (Net Reclassification Improvement, −0,9 %; P = 0,948).
Conclusions
Les scores R2CHADS2 et CHA2DS2-VASc pourraient être utilisés pour prédire les ET des patients souffrant de FA qui
subissent une ablation par cathéter. Dans cette cohorte relativement limitée ayant
subi une ablation, la précision prédictive des deux scores a été similaire.
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Article info
Publication history
Published online: January 15, 2014
Accepted:
January 9,
2014
Received:
October 10,
2013
Footnotes
See editorial by Kornej and Lip, pages 385-387 of this issue.
See page 411 for disclosure information.
Identification
Copyright
© 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
