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Original Research: CARDIOVASCULAR DISEASE |

An Evaluation of the CHADS2 Stroke Risk Score in Patients With Atrial Fibrillation Who Undergo Percutaneous Coronary Revascularization

Juan M. Ruiz-Nodar, MD, PhD; Francisco Marín, MD, PhD; Sergio Manzano-Fernández, MD; José Valencia-Martín, MD, PhD; José A. Hurtado, MD; Vanessa Roldán, MD, PhD; Javier Pineda, MD, PhD; Eduardo Pinar, MD, PhD; Francisco Sogorb, MD, PhD; Mariano Valdés, MD, PhD; Gregory Y. H. Lip, MD
Author and Funding Information

From the Department of Cardiology (Drs Ruiz-Nodar, Valencia-Martín, Pineda, and Sogorb), Hospital General Universitario de Alicante, Alicante, Spain; the Department of Cardiology (Drs Marín, Manzano-Fernández, Hurtado, Pinar, and Valdés), Hospital Universitario Virgen de la Arrixaca, Murcia, Spain; the Department of Hematology (Dr Roldán), Hospital Morales Meseguer, Murcia, Spain; and the University of Birmingham Centre for Cardiovascular Sciences (Dr Lip), City Hospital, Birmingham, England.

Correspondence to: Gregory Y. H. Lip, MD, University of Birmingham Centre for Cadiovascular Sciences, City Hospital, Dudley Rd, Birmingham, B18 7QH, England; e-mail: g.y.h.lip@bham.ac.uk


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(6):1402-1409. doi:10.1378/chest.10-1408
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Background:  There are various schemas designed to stratify the risk of thromboembolism (TE) in patients with atrial fibrillation (AF), of which the CHADS2 (congestive heart failure, hypertension, age ≥ 75 y, diabetes, stroke [doubled]) score is the most widely studied. We evaluated whether the CHADS2 score was adequate for TE risk stratification while assessing cardiac risk in patients with AF revascularized with coronary artery stents.

Methods:  We reviewed 604 consecutive patients with AF treated with at least one stent between 2001 and 2008 in relation to TE risk using CHADS2 score. We stratified our patients with a CHADS2 score ≤ 1 as low-moderate thromboembolic risk (group 1: n = 193, 32%) and > 1 as high risk (and, hence, requiring anticoagulation; group 2: n = 411, 68%). We determined the benefits and/or risks of oral anticoagulation (OAC) therapy in both cohorts.

Results:  Completed follow-up was achieved in 90.4% (mean 642.2 days). Group 1 event-free survival was better than group 2 (major adverse cardiovascular events [MACEs], log-rank test P = .03; and death, log-rank test P = .03). In group 1, event-free survival was better on OAC vs non-OAC use (death 5% vs 15%, P = .04; MACE 10% vs 26%, P < .01) with a trend for more major hemorrhages (12% vs 4%, P = .08). Stroke rate was 4.1% per 100 patient-years in patients without OAC therapy and 1.38% in patients on OAC therapy. Group 2 had a lower incidence of death (20% vs 34%, P < .01) and MACE (26% vs 43%, P < .01) among those on OAC therapy on discharge, with a higher incidence of major hemorrhages (18% vs 8%, P < .01).

Conclusion:  In a population of patients with AF revascularized with stents, even those with CHADS2 ≤ 1 should be regarded as being at high risk. OAC should be considered as thromboprophylaxis in patients with AF revascularized with coronary stents.

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