Effect of CHA2DS2-VASc Implementation in Patients with Atrial Fibrillation Following PCI

Findings from a study, published in the European Journal of Clinical Investigation, showed that the implementation of the Congestive heart failure, Hypertension, Age ≥75 years (doubled), Diabetes, prior Stroke or transient ischemic attack (doubled), Vascular disease, Age 65–74 years, Sex (CHA2DS2-VASc) risk scoring tool in 2010 resulted in the increased use of oral anticoagulation and triple therapy regimens in patients with atrial fibrillation (AFib) undergoing percutaneous coronary intervention (PCI).

 

According to the study’s lead author, Thomas Jensen, the changes resulted in a gradual decline in the risk of major adverse cardiac events (MACEs). The risk of hospitalization for major bleeding remained unchanged, however.

 

The study examined 6,014 patients with AFib undergoing first-time PCI. Subjects were divided into four study groups based on the year of PCI and estimated one-year risk of MACE/hospitalization.

 

After analysis, the researchers reported that, prior to the implementation of the CHA2DS2-VASc score to guide treatment strategy, the proportion of oral anticoagulation users was 48% in 2003-2006 and 49% in 2006-2010

 

Following the implementation, the proportion increased to 59% in 2011-2014, and 77% in 2015-2017. Risks of MACEs were similar to 2003-2006 data in 2007-2010 (adjusted relative risk [RR] = 0.99, 95% confidence interval [CI] 0.83–1.18) and 2011-2014 (RR = 0.92, 95% CI 0.78–1.09) However, the study observed that MACE risk reduced by 23% in 2015-2017 (RR = 0.77, 95% CI 0.65–0.92). Lastly, hospitalizations for bleeding did not increase despite higher use of antiplatelet therapy.

 

The investigators ultimately concluded that development and implementation of the CHA2DS2-VASc score resulted in higher usage of oral anticoagulation and triple therapy in patients with AFib undergoing PCI, leading to lower incidence of MACEs.