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The 2MACE score predicts cardiovascular events in real-world patients with atrial fibrillation: The FANTASIIA registry.

Session Poster session 6

Speaker Maria Asuncion Esteve Pastor

Congress : ESC Congress 2017

  • Topic : preventive cardiology
  • Sub-topic : Risk Factors and Prevention
  • Session type : Poster Session
  • FP Number : P5342

Authors : MA Esteve Pastor (Murcia,ES), J Perez-Copete (Murcia,ES), JM Rivera-Caravaca (Murcia,ES), V Roldan (Murcia,ES), I Roldan Rabadan (Madrid,ES), J Muniz (A Coruna,ES), A Cequier (Barcelona,ES), V Bertomeu-Martinez (Alicante,ES), L Badimon (Barcelona,ES), P Rana Miguez (A Coruna,ES), M Anguita (Cordoba,ES), GYH Lip (Birmingham,GB), F Marin (Murcia,ES)

Authors:
M.A. Esteve Pastor1 , J. Perez-Copete1 , J.M. Rivera-Caravaca2 , V. Roldan2 , I. Roldan Rabadan3 , J. Muniz4 , A. Cequier5 , V. Bertomeu-Martinez6 , L. Badimon7 , P. Rana Miguez4 , M. Anguita8 , G.Y.H. Lip9 , F. Marin1 , 1Hospital Clínico Univeristario Virgen de la Arrixaca, Dept. of Cardiology - Murcia - Spain , 2University Hospital Morales Meseguer, Dept. of Hematology and Clinical Oncology - Murcia - Spain , 3University Hospital La Paz, Dept. of Cardiology - Madrid - Spain , 4Instituto Universitario de Ciencias de la Salud - A Coruna - Spain , 5University Hospital of Bellvitge, Dept. of Cardiology - Barcelona - Spain , 6University Hospital San Juan de Alicante, Dept. of Cardiology - Alicante - Spain , 7Cardiovascular Research Center (CSIC-ICCC) - Barcelona - Spain , 8University Hospital Reina Sofia, Dept. of Cardiology - Cordoba - Spain , 9Birmingham City Hospital, Institute of Cardiovascular Sciences - Birmingham - United Kingdom ,

Citation:
European Heart Journal ( 2017 ) 38 ( Supplement ), 1126-1127

Background: Atrial Fibrillation (AF) is not only associated with an increased risk of stroke, but also with greater risk of organ damage and cardiovascular (CV) outcomes. The 2MACE score [2 points for Metabolic Syndrome and Age ≥75, and 1 point for Myocardial Infarction/revascularization, Congestive heart failure (ejection fraction ≤40%) and thromboembolism (stroke/TIA)] has been described to help cardiovascular risk in non-valvular AF patients.

Purpose: To investigate the incidence of CV events in a “real world” prospective cohort of AF patients included in the FANTASIIA registry. Second, to validate the 2MACE score as predictor of major adverse cardiovascular events (MACEs).

Methods: We analyzed anticoagulated AF patients who were prospectively recruited into the multicentre FANTASIIA registry. Patients were treated with oral anticoagulation with vitamin K antagonists or direct oral anticoagulants, at least 6 months prior to inclusion. We studied CV risk factors and history of vascular disease. Annual incidence of thromboembolic, MACE (composite of nonfatal MI/revascularization, HF and cardiovascular death) and mortality were recorded.

Results: We studied 1,937 patients (55.7% male, mean 73.8±9.4 years). Dyslipidaemia was the most prevalent risk factor (85.9%) followed by hypertension (80.5%), diabetes (29.2%) and metabolic syndrome (54.1%). After a year of follow-up, there were 60 MACE, 84 patients died (35 of CV causes) and 15 patients with stroke. Patients with 2MACE score ≥3 had higher rates of stroke, thromboembolism, total mortality, cardiovascular mortality and MACE compared to 2MACE score<3. A 2MACE score ≥3 was significantly associated with MACE (HR 3.66, 95% CI 2.16–6.22; p<0.001). The predictive performance of 2MACE according to the ROC curve (c-statistic) was 0.676 (CI 0.608–0.745).

Conclusion: In “real world” AF patients, we observed a high risk of cardiovascular events and mortality in AF patients, relative to stroke and embolic complications. The 2MACE score is a good predictor of MACE and a 2MACE score ≥3 can categorize patients at “high risk”, in identifying patients at risk of MACE.

Cardiovascular eventsGLOBAL Population2MACE <32MACE ≥3P value
(%/year), n=1,937(%/year), n=1,327(%/year), n=610
Stroke0.770.250.520.003
Embolism0.880.310.570.003
Myocardial infarction1.080.560.520.11
Total mortality4.331.912.42<0.001
Cardiovascular mortality1.810.521.29<0.001
MACE3.101.191.91<0.001


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