CHADS2 and CHA2DS2-VASc Scores in the Prediction of Clinical Outcomes in Patients With Atrial Fibrillation After Catheter Ablation

Study Questions:

Is the CHADS2 or CHA2DS2-VASc score predictive of thromboembolic events or mortality after radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF)?

Methods:

The subjects of this study were 565 patients (mean age 55 years) who underwent RFCA of AF. The CHADS2 and CHA2DS2-VASc scores were calculated. The primary endpoint was a composite of thromboembolic events or death during follow-up.

Results:

The primary endpoint occurred in 4.8% of patients during a mean follow-up of 39 months. Treatment with warfarin was not predictive of outcomes. The CHADS2 and CHA2DS2-VASc scores were independently associated with the primary endpoint, with no significant difference in predictive value between the two. Among patients with a CHADS2 score <2, a CHA2DS2-VASc cutoff value of 2 discriminated patients in whom the prevalence of the primary endpoint was 1.1% and 7.1%.

Conclusions:

The CHADS2 and CHA2DS2-VASc are both predictive of thromboembolic events or death after RFCA of AF, with the CHA2DS2-VASc score being more discriminating than the CHADS2 score in patients with a low CHADS2 score of 0-1.

Perspective:

The CHA2DS2-VASc score differs from the CHADS2 score in that 2 points are assigned for age ≥75 years and 1 point is assigned for age of 65-75 years, female gender, and vascular disease (myocardial infarction, complex aortic plaque, or peripheral artery disease). The available data suggest that the CHA2DS2-VASc can further stratify patients with AF who are at ‘low risk’ of thromboembolic events based on the CHADS2 score. This study demonstrates that this also is the case after RFCA of AF.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Myocardial Infarction, Plaque, Atherosclerotic, Follow-Up Studies, Heart Atria, Warfarin, Peripheral Arterial Disease, Prevalence, Cardiovascular Diseases, Embolism, Catheter Ablation, Atrial Flutter


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