R2CHADS2 score and thromboembolic events after catheter ablation of atrial fibrillation in comparison with the CHA2DS2-VASc score

Tze-Fan Chao, Yenn-Jiang Lin, Shih-Lin Chang, Li-Wei Lo, Yu-Feng Hu, Ta-Chuan Tuan, Jo-Nan Liao, Fa-Po Chung, Ming-Hsiung Hsieh, Shih-Ann Chen
Canadian Journal of Cardiology 2014, 30 (4): 405-12

BACKGROUND: A new risk model, the R2CHADS2 (Renal Dysfunction, Congestive Heart Failure, Hypertension, Age, Diabetes, Stroke/Transient Ischemic Attack) score, was proposed to be a powerful scoring scheme in predicting stroke or systemic embolism in atrial fibrillation (AF). The goal of the present study is to validate the usefulness of the R2CHADS2 score among patients with AF after catheter ablation. We also aimed to compare the accuracy of the CHA2DS2-VASc (Congestive Heart Failure, Hypertension, Age [≥ 75 y], Diabetes, Stroke/Transient Ischemic Attack, Vascular Disease, Age [65-74 y], Sex [Female]) and R2CHADS2 scores for risk stratification of thromboembolic (TE) events after ablation procedures.

METHODS: We enrolled a total of 526 patients with AF who underwent catheter ablation. The clinical end point was the occurrence of TE events (ischemic stroke, transient ischemic attack, or other systemic embolisms) during the postablation follow-up.

RESULTS: During a follow-up of 37.5 ± 21.3 months, 14 patients (2.7%) experienced TE events. The R2CHADS2 score was an independent predictor of TE events in the multivariate analysis. Patients with an R2CHADS2 score of > 2 had a higher event rate compared with those with a score of 0 or 1 (0.5% vs 7.7%). The areas under the receiver operating characteristic (ROC) curves of CHA2DS2-VASc and R2CHADS2 scores in predicting TE events were 0.832 and 0.872, respectively. The difference between these 2 curves did not reach statistical significance (P = 0.338). In addition, the R2CHADS2 score did not improve net stroke risk reclassification over the CHA2DS2-VASc score (net reclassification improvement, -0.9%; P = 0.948).

CONCLUSIONS: The R2CHADS2 and CHA2DS2-VASc scores could be used to predict TE events for patients with AF undergoing catheter ablation. The predictive accuracy of both scores were similar in this relatively small cohort undergoing ablation.

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