Stroke and Systemic Thromboembolism according to CHA2DS2-VASc Score in Contemporary Korean Patients with Atrial Fibrillation

Kyung Bae Lee, Tae-Hoon Kim, Junbeom Park, Jin-Kyu Park, Ki-Woon Kang, Jun Kim, Hyung Wook Park, Eue-Keun Choi, Jin-Bae Kim, Young Soo Lee, Jaemin Shim, Boyoung Joung, Kyung Bae Lee, Tae-Hoon Kim, Junbeom Park, Jin-Kyu Park, Ki-Woon Kang, Jun Kim, Hyung Wook Park, Eue-Keun Choi, Jin-Bae Kim, Young Soo Lee, Jaemin Shim, Boyoung Joung

Abstract

Purpose: The incidence of stroke and/or systemic thromboembolism (SSE) has not been properly evaluated in well-anticoagulated atrial fibrillation (AF) patients. This study investigated the incidence of SSE according to CHA2DS2-VASc score in contemporary well-anticoagulated Korean AF patients.

Materials and methods: From the prospective multicenter COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation (CODE-AF) registry, we identified 9503 patients with non-valvular AF (mean age, 68±8 years; female 35.5%) enrolled between June 2016 and May 2020 with eligible follow-up visits. Stroke incidence in the CODE-AF registry was compared with that in an oral anticoagulant (OAC)-naïve AF cohort from the Korean National Health Insurance database.

Results: The usage rates of OACs and antiplatelet agents were 73.5% (non-vitamin K OACs, 56.4%; warfarin, 17.1%) and 23.8%, respectively. During a mean follow-up period of 26.3±9.6 months, 163 (0.78 per 100 person-years) patients had SSE. The incidence rate (per 100 person-years) of SSE was 0.77 in the total population, 0.26 in low-risk patients [CHA2DS2-VASc score 0 (male) or 1 (female)], and 0.88 in high-risk patients (CHA2DS2-VASc score ≥2). Contemporary AF patients had a stroke rate that was about one-fifth the stroke rate reported in a Korean OAC-naïve AF cohort. In this cohort, most risk factors for CHA2DS2-VASc score showed significant associations with SSE. Female sex was not associated with an increased risk of stroke/SSE in well-anticoagulated AF patients.

Conclusion: Contemporary AF patients have a stroke rate about one-fifth that in OAC-naïve AF patients and exhibit different stroke risk factors.

Study registration: ClinicalTrials.gov (NCT02786095).

Keywords: Atrial fibrillation; embolism; risk; stroke.

Conflict of interest statement

The authors have no potential conflicts of interest to disclose.

© Copyright: Yonsei University College of Medicine 2022.

Figures

Fig. 1. Flowchart of study cohort enrollment.…
Fig. 1. Flowchart of study cohort enrollment. AF, atrial fibrillation.
Fig. 2. Ischemic stroke endpoint per 100…
Fig. 2. Ischemic stroke endpoint per 100 person-years at risk in relation to CHA2DS2-VASc score. CODE-AF, the COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation; NHIS, National Health Insurance Service.
Fig. 3. Hazard ratios of interaction terms…
Fig. 3. Hazard ratios of interaction terms per risk score level. Model for calculating the risk for thromboembolism: Prob (thromboembolism)=β0+β1 (male)+β2 (i.Score)+β3 (i.Score×male). CI, confidence interval.

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