Abstract

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.
Lingua originaleEnglish
pagine (da-a)143-149
Numero di pagine7
RivistaInternational Journal of Cardiology
Volume231
Stato di pubblicazionePublished - 2017

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Vascular Diseases
Stroke
Atrial Fibrillation
Patents
Doppler Ultrasonography
Peripheral Arterial Disease
Survival Analysis
Observational Studies
Atherosclerosis
Myocardial Infarction
Regression Analysis

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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@article{a8111ff3383240a4add9a75154476522,
title = "Carotid plaque detection improves the predictve value of CHA2DS2-VASc score in patients with non-valvular atrial fibrilation: The ARAPACIS Study",
abstract = "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.",
author = "Giuseppe Melis and Rini, {Giovam Battista} and Alfredo Bargi and Mario Barbagallo and Salzano, {Francesco Antonio} and Giuseppe Mule' and Daniele Torres and Vincenzo Zaccone and Pisano, {Maria Francesca} and {Vanni Di San Vincenzo}, Domitilla and {De Luca}, Nunzio and Antonino Giorgi and {Di Raimondo}, Domenico and Salvatore Corrao and Alessandro Scordo and Claudia Santini and {Lo Sciuto}, Salvatore and Carmelo Butta' and Domenico Spinelli and {Di Miceli}, Enrico and Florence Pellegrini and Cangemi, {Maria Rosaria} and Antonio Castagna and Andrea Fattorini and Glorioso, {Natale Sergio} and {Lo Gullo}, Alessandro and Musumeci, {Carlo Mario Vincenzo Maria} and Oliverio, {Giovanni William} and Alessandra Gabrielli and Mauro Anzaldi",
year = "2017",
language = "English",
volume = "231",
pages = "143--149",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Carotid plaque detection improves the predictve value of CHA2DS2-VASc score in patients with non-valvular atrial fibrilation: The ARAPACIS Study

AU - Melis, Giuseppe

AU - Rini, Giovam Battista

AU - Bargi, Alfredo

AU - Barbagallo, Mario

AU - Salzano, Francesco Antonio

AU - Mule', Giuseppe

AU - Torres, Daniele

AU - Zaccone, Vincenzo

AU - Pisano, Maria Francesca

AU - Vanni Di San Vincenzo, Domitilla

AU - De Luca, Nunzio

AU - Giorgi, Antonino

AU - Di Raimondo, Domenico

AU - Corrao, Salvatore

AU - Scordo, Alessandro

AU - Santini, Claudia

AU - Lo Sciuto, Salvatore

AU - Butta', Carmelo

AU - Spinelli, Domenico

AU - Di Miceli, Enrico

AU - Pellegrini, Florence

AU - Cangemi, Maria Rosaria

AU - Castagna, Antonio

AU - Fattorini, Andrea

AU - Glorioso, Natale Sergio

AU - Lo Gullo, Alessandro

AU - Musumeci, Carlo Mario Vincenzo Maria

AU - Oliverio, Giovanni William

AU - Gabrielli, Alessandra

AU - Anzaldi, Mauro

PY - 2017

Y1 - 2017

N2 - 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.

AB - 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.

UR - http://hdl.handle.net/10447/297908

UR - http://www.elsevier.com/locate/ijcard

M3 - Article

VL - 231

SP - 143

EP - 149

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -