- 著者
- Amaya García-Fernández Francisco Marín Vanessa Roldán José M Gómez-Sansano Diana Hernández-Romero Mariano Valdés Juan G Martinez-Martinez Francisco Sogorb-Garri Gregory YH Lip
- 出版者
- 日本循環器学会
- 雑誌
- Circulation Journal (ISSN:13469843)
- 巻号頁・発行日
- pp.CJ-15-0992, (Released:2016-01-14)
- 参考文献数
- 35
- 被引用文献数
- 1 5
Background:Patients with nonvalvular atrial fibrillation (AF) who undergo electrical cardioversion (ECV) tend to be younger and have less comorbidity. Long-term anticoagulation after ECV should be based on thromboembolic risk. We sought to study the long-term incidence of thromboembolic events (TE), factors related to TE and compare the predictive value of the CHADS2and CHA2DS2-VASc scores in this particular population.Methods and Results:From January 2008 to June 2012, 571 ECV were performed in 406 consecutive patients with nonvalvular AF. Risk factors for TE and factors related to anticoagulation therapy after ECV were registered. During a follow-up of approximately 2 years, the annual incidence of TE was 1.9%. Factors associated with TE were: poor quality anticoagulation control (hazard ratio [HR]: 2.91; 95% confidence interval [CI]: 1.10–7.80; P=0.03), cessation of anticoagulation after ECV (HR: 8.80; 95% CI: 3.11–25.10; P<0.001), age ≥65 years (HR: 13.65; 95% CI: 1.74–107.16; P=0.01), CHADS2score (HR: 1.59; 95% CI: 1.10–2.29; P=0.01) and CHA2DS2-VASc score (HR: 1.67; 95% CI: 1.30–2.22; P<0.001). Both risk scores predicted TE [c-statistic for CHADS2: 0.68 (95% CI: 0.62–0.74; P=0.005), for CHA2DS2-VASc: 0.75 (95% CI: 0.70–0.80; P<0.001)]. Based on c-statistics, the predictive accuracy of CHA2DS2-VASc was superior (difference between areas: 0.064±0.031; P=0.0403).Conclusions:Important determinants of long-term occurrence of TE after ECV were related to anticoagulant therapy (poor quality anticoagulation and cessation of this therapy over follow-up). The CHA2DS2-VASc score successfully predicts TE after ECV, having better predictive accuracy than the CHADS2score.