The predictive value of CHADS2 risk score in post myocardial infarction arrhythmias — A Cardiac Arrhythmias and RIsk Stratification after Myocardial infArction (CARISMA) substudy

Abstract Background Previous studies have shown substantially increased risk of cardiac arrhythmias and sudden cardiac death in post-myocardial infarction (MI) patients. However it remains difficult to identify the patients who are at highest risk of arrhythmias in the post-MI setting. The purpose o...

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Bibliographic Details
Published in:International journal of cardiology 2014-05, Vol.173 (3), p.441-446
Main Authors: Ruwald, Anne Christine, Gang, Uffe, Thomsen, Poul Erik Bloch, Jørgensen, Rikke Mørch, Ruwald, Martin H, Huikuri, Heikki V, Jons, Christian
Format: Article
Language:English
Subjects:
Aged
Arrhythmias
Arrhythmias, Cardiac - diagnosis
Arrhythmias, Cardiac - physiopathology
Arrhythmias, Cardiac - therapy
Atrial fibrillation
Biological and medical sciences
Biomonitor
Bradyarrhythmias
Cardiac dysrhythmias
Cardiology. Vascular system
Cardiovascular
CARISMA study
CHADS2 risk score
Coronary heart disease
Defibrillators, Implantable - trends
Female
Follow-Up Studies
Heart
Humans
Implantable cardiac monitor
Loop recorder
Male
Medical sciences
Middle Aged
Myocardial Infarction - diagnosis
Myocardial Infarction - physiopathology
Myocardial Infarction - therapy
Myocarditis. Cardiomyopathies
Prediction
Predictive Value of Tests
Risk Factors
Severity of Illness Index
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Summary:Abstract Background Previous studies have shown substantially increased risk of cardiac arrhythmias and sudden cardiac death in post-myocardial infarction (MI) patients. However it remains difficult to identify the patients who are at highest risk of arrhythmias in the post-MI setting. The purpose of this study was to investigate if CHADS2 score (congestive heart failure, hypertension, age ≥ 75 years, diabetes and previous stroke/TCI [doubled]) can be used as a risk tool for predicting cardiac arrhythmias after MI. Methods The study included 297 post-MI patients from the CARISMA study with left ventricular ejection fraction (LVEF) ≤ 40%. All patients were implanted with an implantable cardiac monitor (ICM) within 5 to 21 days post-MI and followed every three months for two years. Atrial fibrillation, bradyarrhythmias and ventricular tachycardias were diagnosed using the ICM, pacemaker or ICD. Patients were stratified according to CHADS2 score at enrollment. Congestive heart failure was defined as LVEF ≤ 40% and NYHA class II, III or IV. Results We found significantly increased risk of an arrhythmic event with increasing CHADS2 score (CHADS2 score = 1–2: HR = 2.1 [1.1–3.9], p = 0.021, CHADS2 score ≥ 3: HR = 3.7 [1.9–7.1], p < 0.001). This pattern was identical when dividing the arrhythmias into subgroups of atrial fibrillation, ventricular tachycardias and bradyarrhythmias. CHADS2 score was similarly associated with the development of major cardiovascular events defined as reinfarction, stroke, and hospitalization for heart failure or cardiovascular death. Conclusion In the post-MI setting, CHADS2 score efficiently identifies populations at high risk for cardiac arrhythmias.
ISSN:0167-5273
1874-1754
DOI:10.1016/j.ijcard.2014.03.010