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Atrial Fibrillation Significantly Increases Total Mortality and Stroke Risk Beyond that Conveyed by the CHADS2 Risk Factors
Author(s) -
CRANDALL MARK A.,
HORNE BENJAMIN D.,
DAY JOHN D.,
ANDERSON JEFFREY L.,
MUHLESTEIN JOSEPH B.,
CRANDALL BRIAN G.,
WEISS J. PETER,
OSBORNE JEFFREY S.,
LAPPÉ DONALD L.,
BUNCH T. JARED
Publication year - 2009
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2009.02427.x
Subject(s) - medicine , atrial fibrillation , stroke (engine) , mace , cardiology , myocardial infarction , hazard ratio , heart failure , coronary artery disease , diabetes mellitus , confidence interval , conventional pci , mechanical engineering , engineering , endocrinology
Background: Atrial fibrillation (AF) is associated with an increased risk of mortality and stroke. However, it is unclear if AF is independently associated with these poor outcomes or it is merely a risk marker of other processes that convey the risk.Methods: Consecutive patients who underwent angiography for suspicion of coronary artery disease, but without a history of AF, were studied. Traditional CHADS2 (congestive heart failure, hypertension, age >75 years, diabetes, stroke/transient ischemic attack) risk factors for each patient were recorded.Results: A total of 343 AF patients (age = 69 ± 10 years, 215 [63%] male) and 2,945 non‐AF patients (age = 63 ± 12 years, 2,012 [67%] male) were studied. Among AF patients, 51 (15%) had a myocardial infarction (MI), 35 (10%) had a stroke, and 180 (52%) died. CHADS2 score incrementally increased risk of stroke (adjusted hazard ratio [HR] for 1:1.92, 2:2.30, 3:1.14, 4:3.83, 5:10.96; P‐trend = 0.14), death (HR for 1:1.83, 2:2.34, 3:3.69, 4:2.27, 5:4.53; P‐trend < 0.001), and major adverse cardiac event (MACE)(HR for 1:1.29, 2:1.54, 3:2.07, 4:2.41, 5:2.68; P‐trend = 0.002). Among non‐AF patients, CHADS2 score incrementally increased risk of stroke (HR for 1:1.18, 2:3.17, 3:5.08, 4:10.78, 5:7.50; P‐trend < 0.001), MI (HR for 1:1.05, 2:1.46, 3:1.57, 4:0.53, 5:4.76; P‐trend = 0.002), death (HR for 1:1.79, 2:3.22, 3:6.23, 4:9.09, 5:14.00; P‐trend < 0.001), and MACE (HR for 1:1.47, 2:2.36, 3:4.16, 4:5.91, 5:7.56; P‐trend < 0.001). Among all patients, both CHADS2 score (all P ≤ 0.001) and AF were independent risk factors for stroke (AF: P = 0.002), MI (AF: P = 0.035), death (AF: P < 0.001), and MACE (AF: P < 0.001).Conclusion: The CHADS2 score is a powerful predictor of stroke and death. AF increases the risk of these outcomes in an independent manner. These data support the concept that AF is a risk factor of future cardiovascular disease.