A Novel Model for Prediction of Thromboembolic and Cardiovascular Events in Patients Without Atrial Fibrillation

•Patients without atrial fibrillation constitute 70% to 80% of patients with thromboembolic events•Approximately 75% of thromboembolic events are first-time events•Compilation of multiple independent risk factors predicts ischemic stroke•It is possible to predict ischemic stroke in patients without...

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Bibliographic Details
Published in:The American journal of cardiology 2020-09, Vol.131, p.40-48
Main Authors: Steensig, Kamilla, Olesen, Kevin K W, Madsen, Morten, Thim, Troels, Jensen, Lisette Okkels, Würtz, Morten, Kristensen, Steen Dalby, Bøtker, Hans Erik, Lip, Gregory Y H, Eikelboom, John William, Maeng, Michael
Format: Article
Language:English
Subjects:
Age
Angiography
Cardiac arrhythmia
Cardiovascular disease
Cerebral infarction
Congestive heart failure
Coronary artery
Coronary artery disease
Coronary vessels
Diabetes
Diabetes mellitus
Embolism
Embolisms
Fibrillation
Heart attacks
Heart failure
Hypertension
Ischemia
Myocardial infarction
Patients
Prediction models
Prescriptions
Renal failure
Risk
Stroke
Thromboembolism
Transient ischemic attack
Vascular diseases
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Summary:•Patients without atrial fibrillation constitute 70% to 80% of patients with thromboembolic events•Approximately 75% of thromboembolic events are first-time events•Compilation of multiple independent risk factors predicts ischemic stroke•It is possible to predict ischemic stroke in patients without atrial fibrillation Patients without atrial fibrillation (AF) constitute approximately 75% of patients suffering thromboembolism and major adverse cardiovascular events (MACE), but evidence supporting risk stratification in these patients is sparse. We aimed to develop a risk prediction model for identification of patients without AF at high risk of first-time thromboembolic events. We included 72,381 coronary angiography patients without AF and without previous ischemic stroke or transient ischemic attack. The cohort was randomly divided into a derivation cohort (80%, n = 57,680) and a validation cohort (20%, n = 14,701). The primary thromboembolic end point was a composite of ischemic stroke, transient ischemic attack, and systemic embolism. MACE was defined as a composite of cardiac death, myocardial infarction, and ischemic stroke. The final model was compared with 2 validated clinical risk models (CHADS2 and CHA2DS2-VASc). The risk prediction model assigned 1 point to heart failure, hypertension, diabetes mellitus, renal disease, age 65 to 74 years, active smoking, and multivessel obstructive coronary artery disease, and 2 points to age ≥75 years and peripheral artery disease. A C-index of 0.66 (95% CI 0.64 to 0.69) for prediction of the composite thromboembolic end point was found in the validation cohort, which was higher than for CHADS2 (C-index 0.63 [95% CI 0.60 to 0.67]; p < 0.001) and CHA2DS2-VASc (C-index 0.64 [95% CI 0.62 to 0.67]; p = 0.034). The model also predicted MACE (C-index 0.71 [95% CI 0.69 to 0.73]). In conclusion it is possible to identify patients without AF at high risk of first-time thromboembolic events and MACE by use of a simple clinical prediction model.
ISSN:0002-9149
1879-1913
DOI:10.1016/j.amjcard.2020.06.031