Periferik arter embolisi geçiren atriyal fibrilasyonu olan ve olmayan hastaların CHA2DS2-VASc skoru birbirinden farklı mıdır?

Abstract

Bulgular: Hastaların %59’unda AF saptandı.  AF’li hastaların yaş ortalaması,  kadın cinsiyet oranı, hipertansiyon , kalp yetmezliği , hiperlipidemi  ve inme oranı daha yüksek izlenmiştir (p<0,05). AF hastalarının ortalama CHA2DS2-VASc skoru 5,1±1,7’e 3,5±1,8 p<0,001) AF’si olmayan hastalara göre daha yüksekti. CHA2DS2-VASc skoru 1-3 aralığında olanların oranı AF si olmayan hastalarda daha yüksek iken(%41’e %23 p=0,017)  CHA2DS2-VASc skoru 7-9 aralığında olanların oranı AF grubunda daha yüksek izlenmiştir (%28’e %6 p<0,001). Hastane içi mortalite (%14’e %7 p=0,235) her iki grupta benzerdi.

Gereç ve Yöntem: Bu çalışmada ocak 2011 ve aralık 2016 tarihleri arasında periferik arteryel emboli tanısı alan 150 hastanın kayıtları geriye dönük taranmıştır. Tüm hastaların olay öncesi CHA2DS2-VASc skoru hesaplanmıştır.

Giriş: CHA2DS2-VASc skoru atriyal fibrilasyona (AF) bağlı tromboembolik komplikasyonların risk sınıflandırmasında kullanılan geçerli, pratik bir yöntemdir.  Fakat klinik pratikte kullanımı daha çok inme için olmaktadır. Bu çalışmada periferik arteriyel emboli (PAE) geçiren AF’li ve AF’li olmayan hastaların CHA2DS2-VASc skoru karşılaştırılmıştır.

Sonuç: Atriyal fibrilasyonlu  hastaların CHA2DS2-VASc skor temelli tromboembolik risk düzeyi daha yüksek olmasına rağmen, PAE oranı açısından AF’li ve AF’li olmayan hastalar arasında fark izlenmemiştir.

Keywords

• Atriyal fibrilasyon
• tromboembolizm

Is CHA2DS2-VASc Score different between patients with and without atrial fibrillation suffering from peripheral arterial embolism?

Abstract

Objective: CHA2DS2-VASc is a validated , straightforward and practical stratification of  thromboembolic risk score for  non-valvular atrial fibrillation (NVAF). However it is usually used for stroke. In this trial we aim to compare the CHA2DS2-VASc score between patients with and without AF suffering from peripheral arterial embolism (PAE).

Materials and Methods: We retrospectively evaluated the data registries of 150 patients who admitted to hospital due to PAE between January 2011- December 2016.  CHA2DS2-VASc score was calculated for each patient

Results: Atrial fibrillation was detected 59% of patients.  Patients with AF were elder, more often female gender, hypertension, heart failure, hyperlipidemia, stroke and transient ischemic attack (p<0.05). The rate of prior PAE was similar between two groups (p>0.05). Patients with AF had higher CHA2DS2-VASc score then those without AF (5.1±1.7 vs 3.5±1.8 p<0.001).   The rate of the patients with a CHA2DS2-VASc score 1-3  was higher in non-AF group (41% vs 23% p=0.017. However the rate of the patients with a CHA2DS2-VASc score score 7-9 was higher in AF group (28% vs 6% p<0.001). In-hospital mortality was similar between groups (14% vs 7% p=0.235).

Conclusion: Although AF patients had higher thromboembolic risk level based on CHA2DS2-VASc score. The rate of prior PAE rate was similar between AF and non-AF groups.

Keywords

• Atrial Fibrillation
• Thromboembolism
• CHA2DS2-VASc score

References

1. 1. Albertsen IE, Rasmussen LH, Overvad TF, Graungaard T, Larsen TB, Lip GY. Risk ofstroke or systemic embolism in atrial fibrillation patients treated with warfarin: a systematic review and meta-analysis. Stroke. 2013; 44(5):1329–36.
2. 2. Heeringa J, van der Kuip DA, Hofman A, Kors JA, van Herpen G, Stricker BH et al: Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Eur Heart J 2006; 27(8): 949–53
3. 3. Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey on atrial fibrillation. Chest 2010; 137 (2):263–72.
4. 4. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B et al ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016; 37 (38) :2893-962.
5. 5. Lip GYH and Edwards SJ, “Stroke prevention with aspirin, warfarin and ximelagatran in patients with non-valvular atrial fibrillation: a systematic review and meta-analysis,” Thrombosis Research 2006; 118 (3) : 321–33
6. 6. Lorentzen JE, Roder OC, Buchard Hansen HJ: Peripheral embolism. A follow-up of 130 consecutive patients submitted to embolectomy. Acta Chir Scand 1980; 502: 111–6.
7. 7. Connett MC, Murray DH, Jr, Wenneker WW: Peripheral arterial emboli. Am J Surg 1984; 148 (1): 14–19.
8. 8. Barretto PCA, Nobre MRC, Mansur AJ, Scipioni A, Ramires JA F: Peripheral Arterial Embolism. Report of Hospitalized Cases. Arq Bras Cardiol 2000; 74(4): 324–7.

9. 9. Cambria R P, Abbott WM: Acute arterial thrombosis of the lower extremity. Its natural history contrasted with arterial embolism. Archiv Surgery 1984; 119 (7): 784–7.
10. 10. Silvers LW, Royster TS, Mulcar RJ: Peripheral arterial emboli and factors in their recurrence rate. Ann Surg 1980; 192 (2): 232–6
11. 11. Bekwelem W, Connolly SJ, Halperin JL, Adabag S, Duval S, Chrolavicius S et al. Extracranial Systemic Embolic Events in Patients With Nonvalvular Atrial Fibrillation: Incidence, Risk Factors, and Outcomes. Circulation. 2015;132 (9) :796-803.
12. 12. Karapolat S, Dag O, Abanoz M, Aslan M. Arterial embolectomy: a retrospective evaluation of 730 cases over 20 years. Surg Today 2006; 36 (5): 416-9.
13. 13. Wasilewska M, Gosk-Bierska I. Thromboembolism associated with atrial fibrillation as a cause of limb and organ ischemia. Adv Clin Exp Med 2013; 22 (6): 865-73.
14. 14. Frost L, Engholm G, Johnsen S, Moller H, Henneberg EW, Husted S: Incident thromboembolism in the aorta and the renal, mesenteric, pelvic, and extremity arteries after discharge from the hospital with a diagnosis of atrial fibrillation. Arch Intern Med 2001; 161 (2): 272–6.
15. 15. Acosta S, O¨gren M, Sternby N-H, Bergqvist D, Bjo¨rck M: Fatal nonocclusive mesenteric ischaemia: population- based incidence and risk factors. J Intern Med 2006, 259 (3), 305–13
16. 16. Chu PL, Wei YF, Huang JW, Chen SI, Chu TS, Wu KD. Clinical characteristics of patients with segmental renal infarction. Nephrology (Carlton). 2006;11 (4) :336–40.
17. 17. Hazanov N, Attali M, Somin M, Beilinson N, Goland S, Katz M et al Splenic Embolus: 13 Cases from a Single Medical Department. Isr Med Assoc 2006; 8 (10): 94–7.
18. 18. Hsu PC, Chiu CA, Chu CY, Lee WH, Su HM, Lin TH,et al CHADS2 Score and Risk of New-onset Peripheral Arterial Occlusive Disease in Patients without Atrial Fibrillation: A Nationwide Cohort Study in Taiwan. J Atheroscler Thromb. 2015;22 (5):490-8.