TY - JOUR
T1 - Role of CHADS 2 score in evaluation of thromboembolic risk and mortality in patients with atrial fibrillation undergoing direct current cardioversion (from the ACUTE Trial Substudy)
AU - Yarmohammadi, Hirad
AU - Varr, Brandon C.
AU - Puwanant, Sarinya
AU - Lieber, Elizabeth
AU - Williams, Sarah J.
AU - Klostermann, Tristan
AU - Jasper, Susan E.
AU - Whitman, Christine
AU - Klein, Allan L.
PY - 2012/7/15
Y1 - 2012/7/15
N2 - The CHADS 2 (congestive heart failure, hypertension, age >75 years, diabetes mellitus, stroke or transient ischemic attack [2 points]) scoring scheme has been found to be a good predictor of stroke risk in patients with nonvalvular atrial fibrillation (AF). However, the value of the CHADS 2 scoring system in the risk stratification of patients with AF who undergo direct-current cardioversion has not yet been specifically investigated. In this study, a subgroup of 541 patients from the Assessment of Cardioversion Using Transesophageal Echocardiography (ACUTE) study who had AF for >48 hours and planned to undergo transesophageal echocardiography before direct-current cardioversion were enrolled. Each patient had a CHADS 2 score calculated. Of the patients with CHADS 2 scores of 0, 14 (10%) were found to have left atrial appendage thrombi on transesophageal echocardiography. After 6 months of follow up, patients with CHADS 2 scores of 3 to 6 showed a significantly higher mortality rate in comparison with patients with lower CHADS 2 scores (4.3% vs 0.5%, p = 0.004), despite their similar prevalence of left atrial appendage thrombus and stroke (thrombus: 13.4% vs 11.6%, p = 0.60; stroke: 0% vs 0.3%, p = 0.70). In conclusion, the CHADS 2 scoring system may be useful for predicting short-term mortality risk in patients with AF receiving elective direct-current cardioversion. However, in the preprocedural risk assessment of these patients, the CHADS 2 scoring system is not reliable in predicting risk for left atrial appendage thrombus formation, especially in patients with low CHADS 2 scores.
AB - The CHADS 2 (congestive heart failure, hypertension, age >75 years, diabetes mellitus, stroke or transient ischemic attack [2 points]) scoring scheme has been found to be a good predictor of stroke risk in patients with nonvalvular atrial fibrillation (AF). However, the value of the CHADS 2 scoring system in the risk stratification of patients with AF who undergo direct-current cardioversion has not yet been specifically investigated. In this study, a subgroup of 541 patients from the Assessment of Cardioversion Using Transesophageal Echocardiography (ACUTE) study who had AF for >48 hours and planned to undergo transesophageal echocardiography before direct-current cardioversion were enrolled. Each patient had a CHADS 2 score calculated. Of the patients with CHADS 2 scores of 0, 14 (10%) were found to have left atrial appendage thrombi on transesophageal echocardiography. After 6 months of follow up, patients with CHADS 2 scores of 3 to 6 showed a significantly higher mortality rate in comparison with patients with lower CHADS 2 scores (4.3% vs 0.5%, p = 0.004), despite their similar prevalence of left atrial appendage thrombus and stroke (thrombus: 13.4% vs 11.6%, p = 0.60; stroke: 0% vs 0.3%, p = 0.70). In conclusion, the CHADS 2 scoring system may be useful for predicting short-term mortality risk in patients with AF receiving elective direct-current cardioversion. However, in the preprocedural risk assessment of these patients, the CHADS 2 scoring system is not reliable in predicting risk for left atrial appendage thrombus formation, especially in patients with low CHADS 2 scores.
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U2 - 10.1016/j.amjcard.2012.03.017
DO - 10.1016/j.amjcard.2012.03.017
M3 - Article
C2 - 22503581
AN - SCOPUS:84862775557
SN - 0002-9149
VL - 110
SP - 222
EP - 226
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 2
ER -
