Cardiovascular risk stratification in patients with non-valvular atrial fibrillation: the 2MACE score

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• 作者：Daniele Pastori ; Alessio Farcomeni ; Daniela Poli…
• 关键词：Atrial fibrillation ; Myocardial infarction ; Metabolic syndrome ; Risk score ; Cardiovascular events
• 刊名：Internal and Emergency Medicine
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：11
• 期：2
• 页码：199-204
• 全文大小：354 KB
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• 作者单位：Daniele Pastori (1)
  Alessio Farcomeni (2)
  Daniela Poli (3)
  Emilia Antonucci (4)
  Francesco Angelico (2)
  Maria Del Ben (1)
  Roberto Cangemi (1)
  Gaetano Tanzilli (6)
  Gregory Yoke Hong Lip (5)
  Pasquale Pignatelli (1)
  Francesco Violi (1)
  
  1. I Clinica Medica, Atherothrombosis Center, Department of Internal Medicine and Medical Specialties, “Sapienza” University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
  2. Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, Rome, Italy
  3. Thrombosis Centre, Department of Heart and Vessels, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
  4. Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
  6. Department of the Heart and Great Vessels Attilio Reale, “Sapienza” University of Rome, Rome, Italy
  5. Centre for Cardiovascular Sciences, City Hospital, University of Birmingham, Birmingham, UK
  
• 刊物主题：Internal Medicine;
• 出版者：Springer Milan
• ISSN：1970-9366

文摘

Recent findings suggest that patients with non-valvular atrial fibrillation (AF), in addition to having a high risk for ischemic stroke, are also at risk for myocardial infarction (MI). The aim of the study was to combine factors predicting Major Adverse Cardiovascular Events (MACE) in AF patients, including fatal/nonfatal MI, cardiac revascularization, and cardiovascular death, into a simple risk score. Predictors of MACE were obtained from a prospective observational cohort study, including 1019 AF patients taking vitamin K antagonists from the Atherothrombosis Center, of Sapienza University of Rome. Thus, we derived the 2MACE score [2 points for Metabolic Syndrome and Age ≥75, 1 point for MI/revascularization, Congestive heart failure (ejection fraction ≤40 %), thrombo-Embolism (stroke/transient ischemic attack)], ranging from 0 to 7 points. To evaluate the 2MACE score, we included an external validation cohort of 1089 anticoagulated AF patients from the Thrombosis Centre of Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy. At follow-up, 111 AF patients in the internal and 68 in the external cohort experienced a MACE. The 2MACE score showed a good ability in discriminating AF patients experiencing MACE both in the internal derivation cohort, with a c-index of 0.79 [95 % Confidence Interval (CI) 0.71–0.90, p < 0.001] and in the external validation cohort (c-index 0.66, 95 % CI 0.60–0.73, p < 0.001). The overall Hazard Ratio (HR) was 1.61 (95 % CI 1.40–1.85, p < 0.001) for each additional point. A 2MACE score ≥3 had the best combination of specificity and sensitivity, with an HR of 3.92 (95 % CI 2.41–6.40, p < 0.001). The new simple 2MACE score may help identifying AF patients at risk for cardiovascular events.