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.