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Is CHA2DS2VASc score reliable as prognostic marker in atrial flutter?
Session:
Posters - C. Arrhythmias and Device Therapy
Speaker:
Pedro Silvério António
Congress:
CPC 2021
Topic:
C. Arrhythmias and Device Therapy
Theme:
06. Supraventricular Tachycardia (non-AF)
Subtheme:
06.2 Supraventricular Tachycardia (non-AF) - Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Pedro Silvério António; Tiago Rodrigues; Joana Brito; Sara Couto Pereira; Nelson Cunha; Pedro Alves da Silva; Beatriz Silva; Beatriz Garcia; Catarina Oliveira; Ana Margarida Martins; Ana Bernardes; Gustavo Lima da Silva; Nuno Cortez-Dias; Luís Carpinteiro; Fausto j Pinto; João de Sousa
Abstract
<p style="text-align:justify"><span style="font-family:Calibri"><strong><span style="font-size:11,0000pt"><span style="font-family:Calibri"><strong>Introduction</strong></span></span></strong><span style="font-size:11,0000pt"><span style="font-family:Calibri">: CHA</span></span><sub><span style="font-size:11,0000pt"><span style="font-family:Calibri">2</span></span></sub><span style="font-size:11,0000pt"><span style="font-family:Calibri">DS</span></span><sub><span style="font-size:11,0000pt"><span style="font-family:Calibri">2</span></span></sub><span style="font-size:11,0000pt"><span style="font-family:Calibri">VASc score is a well stablished prognostic score in atrial fibrillation population. However, considering patients with isolated atrial flutter no prognostic score are defined, regarding the embolic risk of this population.</span></span></span></p> <p style="text-align:justify"><span style="font-family:Calibri"><strong><span style="font-size:11,0000pt"><span style="font-family:Calibri"><strong>Purpose</strong></span></span></strong><span style="font-size:11,0000pt"><span style="font-family:Calibri">: To evaluate the accuracy of CHA</span></span><sub><span style="font-size:11,0000pt"><span style="font-family:Calibri">2</span></span></sub><span style="font-size:11,0000pt"><span style="font-family:Calibri">DS</span></span><sub><span style="font-size:11,0000pt"><span style="font-family:Calibri">2</span></span></sub><span style="font-size:11,0000pt"><span style="font-family:Calibri">VASc</span></span><span style="font-size:11,0000pt"><span style="font-family:Calibri"> score to predict cardiovascular death and </span></span><span style="font-size:11,0000pt"><span style="font-family:Calibri">major adverse cardiovascular events (MACE) </span></span><span style="font-size:11,0000pt"><span style="font-family:Calibri">in flutter patients (pts).</span></span></span></p> <p style="text-align:justify"><span style="font-family:Calibri"><strong><span style="font-size:11,0000pt"><span style="font-family:Calibri"><strong>Methods: </strong></span></span></strong><span style="font-size:11,0000pt"><span style="font-family:Calibri">Single-center retrospective study of pts submitted to CTA between 2015 and 2019, comprising two groups: I – pts with lone AFL; II – patients with AFL and after CTA documented AF. Clinical records were analyzed to determine the occurrence of MACE during the long-term follow up, defined as death (of cardiovascular or unknown cause), stroke, clinically relevant bleed or hospitalization due to heart failure or arrhythmic events. </span></span><span style="font-size:11,0000pt"><span style="font-family:Calibri">CHA</span></span><sub><span style="font-size:11,0000pt"><span style="font-family:Calibri">2</span></span></sub><span style="font-size:11,0000pt"><span style="font-family:Calibri">DS</span></span><sub><span style="font-size:11,0000pt"><span style="font-family:Calibri">2</span></span></sub><span style="font-size:11,0000pt"><span style="font-family:Calibri">VASc</span></span><span style="font-size:11,0000pt"><span style="font-family:Calibri"> score was categorized into 3 groups: 0-1; 2-3; >4. Kaplan Meier survival curves were used to estimate the risk of events and the groups were compared using uni- and multivariate Cox regression analyses, adjusted to the long-term treatment with anticoagulation.</span></span></span></p> <p style="text-align:justify"><span style="font-family:Calibri"><strong><span style="font-size:11,0000pt"><span style="font-family:Calibri"><strong>Results</strong></span></span></strong><span style="font-size:11,0000pt"><span style="font-family:Calibri">: </span></span></span></p> <p style="text-align:justify"><span style="font-family:Calibri"><span style="font-size:11,0000pt"><span style="font-family:Calibri">A total of 476 pts (66±12 years, 80% males), underwent CTA: group I – 284 pts (60%), II – 192 pts (40%). </span></span><span style="font-size:11,0000pt"><span style="font-family:Calibri">Baseline characteristics were similar between groups, except for age, with group I pts being older (68±12, 64±11, p<0.01). The mean baseline CHA</span></span><sub><span style="font-size:11,0000pt"><span style="font-family:Calibri">2</span></span></sub><span style="font-size:11,0000pt"><span style="font-family:Calibri">DS</span></span><sub><span style="font-size:11,0000pt"><span style="font-family:Calibri">2</span></span></sub><span style="font-size:11,0000pt"><span style="font-family:Calibri">VASc was 2.3±1.5 and the median post-CTA follow-up was 2.8 year.</span></span></span></p> <p style="text-align:justify"><span style="font-family:Calibri"><span style="font-size:11,0000pt"><span style="font-family:Calibri">CHA</span></span><sub><span style="font-size:11,0000pt"><span style="font-family:Calibri">2</span></span></sub><span style="font-size:11,0000pt"><span style="font-family:Calibri">DS</span></span><sub><span style="font-size:11,0000pt"><span style="font-family:Calibri">2</span></span></sub><span style="font-size:11,0000pt"><span style="font-family:Calibri">VASc score </span></span><span style="font-size:11,0000pt"><span style="font-family:Calibri">was identified as strong predictor of MACE after CTA, with the risk of events being twice higher in pts with a 2-3 score (HR: 2.11 95%CI 1.09-4.12, p=0.027) and four times increased in these with a score ≥ 4 (HR: 4.45 95%CI 2.24-8.84, p<0.001).</span></span></span></p> <p style="text-align:justify"><span style="font-family:Calibri"><span style="font-size:11,0000pt"><span style="font-family:Calibri">CHA</span></span><sub><span style="font-size:11,0000pt"><span style="font-family:Calibri">2</span></span></sub><span style="font-size:11,0000pt"><span style="font-family:Calibri">DS</span></span><sub><span style="font-size:11,0000pt"><span style="font-family:Calibri">2</span></span></sub><span style="font-size:11,0000pt"><span style="font-family:Calibri">VASc</span></span><span style="font-size:11,0000pt"><span style="font-family:Calibri"> score was an independent predictor of cardiovascular death (HR: 1.49 95%CI 1.09-1.79, p=0.08) and was </span></span><span style="font-size:11,0000pt"><span style="font-family:Calibri">a predictor of MACE even after adjustment for the diagnose of </span></span><span style="font-size:11,0000pt"><span style="font-family:Calibri">prior AF (HR 1.88, 95% CI 1.094-3.249, p=0.022) or persistence an oral anticoagulation during the long term.</span></span></span></p> <p style="text-align:justify"><span style="font-family:Calibri"><span style="font-size:11,0000pt"><span style="font-family:Calibri">CHA</span></span><sub><span style="font-size:11,0000pt"><span style="font-family:Calibri">2</span></span></sub><span style="font-size:11,0000pt"><span style="font-family:Calibri">DS</span></span><sub><span style="font-size:11,0000pt"><span style="font-family:Calibri">2</span></span></sub><span style="font-size:11,0000pt"><span style="font-family:Calibri">VASc score remained as a significant predictor </span></span><span style="font-size:11,0000pt"><span style="font-family:Calibri">(HR 1.36, 95% CI 0.16-0.77, p<0.009)</span></span><span style="font-size:11,0000pt"><span style="font-family:Calibri">, even after adjustment for the presence of concomitant AF on long-term persistence of oral anticoagulation after CTA </span></span><span style="font-size:11,0000pt"><span style="font-family:Calibri">(HR 0.35, 95% IC 0.16-0.77, p<0.009).</span></span></span></p> <p style="text-align:justify"><span style="font-family:Calibri"><span style="font-size:11,0000pt"><span style="font-family:Calibri">Of note, the stroke was component of the composite endpoint that contributed the most for the prognostic impact of the CHA</span></span><sub><span style="font-size:11,0000pt"><span style="font-family:Calibri">2</span></span></sub><span style="font-size:11,0000pt"><span style="font-family:Calibri">DS</span></span><sub><span style="font-size:11,0000pt"><span style="font-family:Calibri">2</span></span></sub><span style="font-size:11,0000pt"><span style="font-family:Calibri">VASc</span></span><span style="font-size:11,0000pt"><span style="font-family:Calibri"> score (HR 1.72, 95% CI 1.24-2.40, p=0.001).</span></span></span></p> <p style="text-align:justify"><span style="font-family:Calibri"><strong><span style="font-size:11,0000pt"><span style="font-family:Calibri"><strong>Conclusions</strong></span></span></strong><span style="font-size:11,0000pt"><span style="font-family:Calibri">: </span></span></span></p> <p style="text-align:justify"><span style="font-family:Calibri"><span style="font-size:11,0000pt"><span style="font-family:Calibri">In our population CHA</span></span><sub><span style="font-size:11,0000pt"><span style="font-family:Calibri">2</span></span></sub><span style="font-size:11,0000pt"><span style="font-family:Calibri">DS</span></span><sub><span style="font-size:11,0000pt"><span style="font-family:Calibri">2</span></span></sub><span style="font-size:11,0000pt"><span style="font-family:Calibri">VASc score was able to predict MACE events and stroke in patients with isolated atrial flutter. This suggests that in the future CHA</span></span><sub><span style="font-size:11,0000pt"><span style="font-family:Calibri">2</span></span></sub><span style="font-size:11,0000pt"><span style="font-family:Calibri">DS</span></span><sub><span style="font-size:11,0000pt"><span style="font-family:Calibri">2</span></span></sub><span style="font-size:11,0000pt"><span style="font-family:Calibri">VASc score could be applied to establish embolic risk in atrial flutter.</span></span></span></p>
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