Study Shows Renal Impairment Has No Risk Predictive Value in AFib Patients
A study published on March 19 in the Journal of the American College of Cardiology that was designed to determine the risk of ischemic stroke and thromboembolism (IS/TE)-associated renal impairment in patients with non-valvular atrial fibrillation found that renal impairment was not an independent predictor of IS/TE risk at one year and did not have incremental predictive value over established risk-stratification scores.
Twenty-six percent of these patients (1,537) had renal impairment. Renal impairment was defined as a reported history of renal failure or a baseline serum creatinine level of >133 µmol/dL in men and >115 µmol/dL in women. The investigators calculated the estimated glomerular filtration rate (eGFR) for each patient and recorded outcomes regarding thromboembolism, stroke, bleeding and all-cause mortality for one year.
They also calculated established risk-stratification scores for each patient — CHADS2 and CHA2DS2-VASc — and used these scores to calculate the overall rates of IS/TE.
Patients with renal impairment were older, more likely to be male, less likely to have paroxysmal atrial fibrillation, more likely to have comorbidities, and were at higher risk of stroke/TE and bleeding than those without renal impairment. Patients with renal impairment had higher rates of stroke/TE than those without renal impairment at one year, and patients with an eGFR >30 ml/min/1.73 m2 had higher rates of stroke/TE than patients with an eGFR ranging from 30 to 59 ml/min/1.73 m2 at one year.
However, after the results were adjusted for CHADS2 risk factors, renal impairment was not found to be associated with a significant increase in the risk of IS/TE. In addition, when the factor of renal impairment was added to the CHADS2 and CHA2DS2-VASc scores, it did not independently add to the predictive value of these risk-stratification scores, the authors conclude.
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