Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Mar;28(2):e13036.
doi: 10.1111/anec.13036. Epub 2023 Jan 10.

Predictors of stroke or systemic embolism in patients with non-valvular atrial fibrillation with CHA2 DS2 -VASc score of 0

Hyohun Choi  1 , Myung Hwan Bae  1   2 , Yoon Jung Park  1 , Hyuk Kyoon Park  1 , Eunkyu Lee  1 , Myeong Seop Kim  1 , Jong Sung Park  1 , Hyeon Jeong Kim  1 , Bo Eun Park  1 , Hong Nyun Kim  1   2 , Namkyun Kim  1   2 , Jang Hoon Lee  1   2 , Se Yong Jang  1   2 , Dong Heon Yang  1   2 , Hun Sik Park  1   2 , Yongkeun Cho  1   2
Affiliations

Predictors of stroke or systemic embolism in patients with non-valvular atrial fibrillation with CHA2 DS2 -VASc score of 0

Hyohun Choi et al. Ann Noninvasive Electrocardiol. 2023 Mar.

Abstract

Background: Anticoagulant therapy has been important for stroke prevention in patients with atrial fibrillation (AF). However, it was not recommended due to its relatively higher risk of bleeding than its lower risk of stroke in patients with a CHA2 DS2 -VASc score of 0.

Hypothesis: This study aimed to evaluate the predictors of stroke in AF patients with very low risk of stroke.

Methods: Between 1990 and 2020, 542 patients with non-valvular AF (NVAF) with a CHA2 DS2 -VASc score of 0 followed up for at least 6 months were enrolled. Patients with only being woman as a risk factor were included as a CHA2 DS2 -VASc score of 0 in this study. The primary outcome was stroke or systemic embolism.

Results: The primary outcome rate was 0.78%/year. In Cox hazard model, age of ≥50 years at diagnosis (hazard ratio [HR] 6.710, 95% confidence interval [CI] 1.811-24.860, p = .004), LVEDD of ≥46 mm (HR 4.513, 95% CI 1.038-19.626, p = .045), and non-paroxysmal AF (HR 5.575, 95% CI 1.621-19.175, p = .006) were identified as independent predictors of stroke or systemic embolism. Patients with all three independent predictors had a higher risk of stroke or systemic embolism (4.21%/year), whereas those without did not have a stroke or systemic embolism.

Conclusion: The annual stroke or systemic embolism rate in NVAF patients with CHA2 DS2 -VASc score of 0 was 0.78%/year, and age at AF diagnosis, LVEDD, and non-paroxysmal AF were independent predictors of stroke or systemic embolism in patients considered to have a very low risk of stroke.

Keywords: anticoagulants; atrial fibrillation; risk factors; stroke.

PubMed Disclaimer

Conflict of interest statement

All authors have no potential conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Kaplan–Meier survival curves for stroke/systemic embolism based on sex, type of AF, age at diagnosis, and LVEDD. AF, atrial fibrillation; LVEDD, left ventricular end‐diastolic dimension.
FIGURE 2
FIGURE 2
Annual rates of stroke/systemic embolism are categorized based on the total values defined by the presence or absence of independent stroke and/or systemic embolism predictors (age ≥ 50 years at diagnosis, non‐paroxysmal AF, and LVEDD of ≥46 mm). AF, atrial fibrillation; LVEDD, left ventricular end‐diastolic dimension.
FIGURE 3
FIGURE 3
Kaplan–Meier survival curves for stroke/systemic embolism based on the total values defined by the presence or absence of independent stroke and/or systemic embolism predictors.
FIGURE 4
FIGURE 4
Area under the receiver operating characteristics curve for the prediction of stroke/systemic embolism for four risk factor groups based on the total values defined by the presence or absence of independent predictors of stroke and/or systemic embolism.
See this image and copyright information in PMC

Comment in

References

    1. Al‐Khatib, S. M. , Thomas, L. , Wallentin, L. , Lopes, R. D. , Gersh, B. , Garcia, D. , Ezekowitz, J. , Alings, M. , Yang, H. , Alexander, J. H. , Flaker, G. , Hanna, M. , & Granger, C. B. (2013). Outcomes of apixaban vs. warfarin by type and duration of atrial fibrillation: Results from the ARISTOTLE trial. European Heart Journal, 34(31), 2464–2471. - PubMed
    1. Benjamin, E. J. , Levy, D. , Vaziri, S. M. , D'Agostino, R. B. , Belanger, A. J. , & Wolf, P. A. (1994). Independent risk factors for atrial fibrillation in a population‐based cohort. The Framingham Heart Study. JAMA, 271(11), 840–844. - PubMed
    1. Benz, A. P. , Hijazi, Z. , Lindbäck, J. , Connolly, S. J. , Eikelboom, J. W. , Oldgren, J. , Siegbahn, A. , & Wallentin, L. (2021). Biomarker‐based risk prediction with the ABC‐AF scores in patients with atrial fibrillation not receiving Oral anticoagulation. Circulation, 143(19), 1863–1873. - PubMed
    1. Berg, D. D. , Ruff, C. T. , Jarolim, P. , Giugliano, R. P. , Nordio, F. , Lanz, H. J. , Mercuri, M. F. , Antman, E. M. , Braunwald, E. , & Morrow, D. A. (2019). Performance of the ABC scores for assessing the risk of stroke or systemic embolism and bleeding in patients with atrial fibrillation in ENGAGE AF‐TIMI 48. Circulation, 139(6), 760–771. - PMC - PubMed
    1. Citerni, C. , Kirchhoff, J. , Olsen, L. H. , Sattler, S. M. , Gentilini, F. , Forni, M. , Zannoni, A. , Grunnet, M. , Edvardsson, N. , Bentzen, B. H. , & Diness, J. G. (2020). Characterization of atrial and ventricular structural remodeling in a porcine model of atrial fibrillation induced by atrial Tachypacing. Frontiers in Veterinary Science, 7, 179. - PMC - PubMed