Carotid plaque detection improves the predictve value of CHA2DS2-VASc score in patients with non-valvular atrial fibrilation: The ARAPACIS Study

Giovanni Cerasola, Antonino Tuttolomondo, Michele Cillino, Alessandro Scordo, Antonio Pinto, Fabrizio Parente, Alfredo Galasso, Alessia Pedace, Domenico Di Raimondo, Giuseppa Castellino, Mario Barbagallo, Giovam Battista Rini, Federica Bazza, Alberto Utili, Alessandra Gabrielli, Andrea Fattorini, Carlo Ferrigno, Carlo Mario Vincenzo Maria Musumeci, Daniela Angelucci, Fabio PastorellaFilippo Valente, Giovanni William Oliverio, Isabella Bruni, Maria Catena Macaluso, Maria Gabriella Pasqualini, Mauro Anzaldi, Michele Maria Vecchio, Roberta Conigliaro, Rosario Migliaccio, Salvatore Napoleone, Stefania Contrino, Vincenzo Zaccone

Research output: Contribution to journalArticlepeer-review

14 Citations (Scopus)


Background and aims: Vascular disease (VD), as assessed by history of myocardial infarction or peripheral artery disease or aortic plaque, increases stroke risk in atrial fibrillation (AF), and is a component of risk assessment using the CHA2DS2-VASc score. We investigated if systemic atherosclerosis as detected by ultrasound carotid plaque (CP) could improve the predictive value of the CHA2DS2-VASC score. Methods: We analysed data from the ARAPACIS study, an observational study including 2027 Ialian patents with non-valvular AF, in whom CP was detected using Doppler Ultrasonography. Results: VD was reported in 351 (17.3%) patients while CP was detected in 16.6% patents. Adding CP to the VD definition leaded to higher VD prevalence (30.9%). During a median [IQR] follow-up time of 36 months, 56 (2.8%) stroke/TIA events were recorded. Survival analysis showed that conventional VD alone did not increase the risk of stroke (Log-Rank: 0.009, p = 0.924), while addition of CP to conventional VD was significantly associated to an increased risk of stroke (LR: 5.730, p = 0.017). Cox regression analysis showed that VD + CP was independently associated with stroke (HR: 1.78, 95% CI: 1.05-3.01, p = 0.0318). Reclassification analysis showed that VD + CP allowed a significant risk reclassification when compared to VD alone in predicting stroke at 36 months (NRI: 0.192, 95% CI: 0.028-0.323, p = 0.032). Conclusions: In non-valvular AF patients the addition of ultrasound detection of carotid plaque to conventional VD significantly increases the pedictive value of CHA2DS2-VASc score for stroke.
Original languageEnglish
Pages (from-to)143-149
Number of pages7
Publication statusPublished - 2017

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine


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