Mid-term Risk Stratification of Patients with a Myocardial Infarction and Atrial Fibrillation: Beyond GRACE and CHADS

Journal of Atrial Fibrillation
Sérgio BarraAntónio Leitão Marques

Abstract

Background: We hypothesize that the discriminative performance of GRACE, ACHTUNG-Rule, CHADS2 or CHA2DS2-VASc may be lower in patients with a Myocardial Infarction (MI) and concurrent atrial fibrillation (AF), as none of these scores seem able to fully capture both atherothrombotic/thromboembolic risks. This study aims to evaluate the mid-term prognostic performance of these algorithms in patients with these two conditions and to analyze the utility of a score combining GRACE and CHA2DS2-VASc. Methods: Observational retrospective single-centre cohort study including 1852 patients admitted with a MI. We tested the prognostic performance of the aforementioned risk stratification schemes in patients with vs. without AF at admission or during hospitalization. Primary endpoints: a) total all-cause mortality, comprising intrahospital and post-discharge all-cause mortality; b) intrahospital all-cause mortality and c) all-cause mortality during follow-up. Furthermore, all three versions of the ACHTUNG-Rule were directly compared to their equivalent GRACE score versions, and a new score, entitled GRACE-CHA2DS2-VASc, was developed and compared with GRACE. Results: The mid-term prognostic performance of all scores was considerably lower i...Continue Reading

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