SPC365

De novo atrial fibrillation in acute coronary syndromes: is CHAD2S2VASc useful?

Session: Posters - E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Speaker: Mariana da Silva Santos

Congress: CPC 2021
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 13. Acute Coronary Syndromes
Subtheme: 13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type: Posters
FP Number: ---
Authors: Mariana Da Silva Santos; Helder Santos; Ines Almeida; Hugo Miranda; Catarina sa; Joana Chin; Samuel Almeida; Catarina Sousa; João Tavares; Luis Santos; Maria Lurdes Almeida

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Background: </span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Acute Coronary Syndromes (ACS) are a common pathology with important morbidity and mortality rates. There were proposed several scores trying to identify patients (pts) at higher risk of worse prognosis in short and long-term outcomes. CHA2DS2-VASc score (CVS) was validated as a tool to estimate the risk of stroke in pts with atrial fibrillation (AF), helping deciding when to initiate anticoagulation therapy in AF pts.&nbsp; &nbsp;</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Objective:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> To validate CVS as a prognosis score in de novo AF in ACS setting.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Methods:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-4/09/2019. Pts with de novo AF in the setting of ACS were selected. The CVS was tested as a predictor of de novo AF. According with the CVS punctuation (0, 1 and &ge;2), Kaplan-Meier analysis was performed to establish the survival rates and cardiovascular re-admission (CRA) at one year follow-up.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Results:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> 25727 pts had ACS, 1067 (2.6%) presented de novo atrial fibrillation (AF).&nbsp; Between the de novo AF pts, 64.2% were male (vs 72.7% in pts who didn&rsquo;t develop de novo AF, p&lt;0.001) and average age was 75&plusmn;12 (vs 66&plusmn;14, p&lt;0.001); regarding past history, 75.6% (vs 70.4%, p&lt;0.001) had arterial hypertension, 34.6% (vs 31.4%, p=0.029) were diabetic, 11.5% (vs 5.7%, p&lt;0.001) had history of heart failure, 11.3% (vs 7.0%, p&lt;0.001) had history of stroke, 18.2% (vs 20.6%, p=0.062), had history of ACS and 8.1% (vs 5.4%, p&lt;0.001) had peripheral arterial disease. Regarding major adverse cardiovascular events (MACE), AF pts had higher rates of re-infarction (2.5% vs 0.8%, p&lt;0.001), heart failure (45.7% vs 14.3%, p&lt;0.001), cardiogenic shock (16.1% vs 3.6, p&lt;0.001), mechanical complications (1.8% vs 0.6%, p&lt;0.001), atrioventricular block (8.0% vs 2.2%, p&lt;0.001), maintained ventricular tachycardia (7.8% vs 1.1%, p&lt;0.001), cardiac arrest (9.2% vs 2.4%, p&lt;0.001), stroke (2.0% vs 0.6%, p&gt;0.001), major hemorrhage (4.1% vs 1.4%, p&lt;0.001). In-hospital death rate was 11.0% (vs 3.4%, p&lt;0.001). It was possible to calculate the CVS in 1023 AF pts &ndash; 60 scored 0 points, 121 score 1 point and 842 scored &ge;2 points. Logistic regression revealed that the CVS score was a predictor of <em>de novo</em> AF in ACS (<em>odds ratio</em> (OR) 2.07, <em>p</em>&lt;0.001, CI 1.74-2.47), with acceptable accuracy (area under curve 0.642, confidence interval 0.625-0.659). Regarding MACE rate in AF pts, CVS was predictive of heart failure (p=0.049) and cardiac arrest (p=0.001). Regarding follow-up, survival analysis revealed that higher CVS was associated with higher rates of 1-year mortality or CRS (composite outcome) (p=0.016).</span></span></span></span></p>

<p><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Conclusions</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: CHA2DS2-VASc score was a predictor of <em>de novo</em> AF in ACS and may be used as a prognostic tool regarding follow-up outcomes, namely mortality and CRA.</span></span></p>