Different prediction power of ESRD by CHA2DS2-VASc score in AF patients with or without prior myocardial infarction
P S Huang, J F Cheng, C T TsaiAbstract
Background
The coexistence of coronary artery disease (CAD) and atrial fibrillation (AF) significantly increases morbidity and mortality risk. The correlation of the CHA2DS2-VASc score with many cardiovascular disease outcomes is widely recognized. The extent to which the CHA2DS2-VASc score can predict the development of end stage renal disease in the future is uncertain. This study aimed to determine whether the CHA2DS2-VASc score could predict the risk of progression to end stage renal disease in AF patients, with or without a previous MI event.
Methods
This retrospective cohort study included patients diagnosed with AF between January 2010 and December 2020, with a median follow-up of 5 years. The study recorded clinical parameters and baseline characteristics, and defined the endpoint as the occurrence of an end stage renal disease event.
Results
There were 29,341 participants in the study cohort, with a median age of 71.0 years. Of these, 43.2% were male, 21.5% had diabetes mellitus, 46.1% had hypertension, 3.3% had prior MI and the mean CHA2DS2-VASc score was 2.89. During the follow-up period, the group with a history of MI had a higher incidence of incident renal failure events, with 17.3%, compared to 8.1% in the group without prior MI. In the prior MI group, the univariate Cox model showed an 18.9% increase in renal failure risk with each CHA2DS2-VASc score point increase (HR 1.189 [1.101-1.284], P < 0.001), while the non-prior MI group showed a 23.9% increase (HR 1.239 [1.212-1.266], P < 0.001). Adjusting for anti-thrombotic agent use and CKD stage using the multi-variate Cox model, the prior MI group still had an non-significant 2.4% decrease in renal failure risk (HR 0.976 [0.895-1.063], P = 0.574), but the non-prior MI group only had a 2.6% increase (HR 1.026 [1.003-1.050], P = 0.026). We utilize receiver operating characteristic (ROC) curves to evaluate distinct scoring systems that predict future incidents of ESRD. Specifically, we explore the impact of adding one or two points to the CHA2DS2-VASc score when there is a history of MI. Our analysis reveals that there is no significant difference between the three scoring systems, with separate AUC values of 0.624, 0.626, and 0.626.
Conclusion
In AF patients, the CHA2DS2-VASc score can be used to predict future renal failure events with moderate accuracy without prior MI history.