title: An evaluation of the CHADS₂ stroke risk score in patients with atrial fibrillation who undergo percutaneous coronary revascularization.
abstract: BACKGROUND
  There are various schemas designed to stratify the risk of thromboembolism (TE) in patients with atrial fibrillation (AF), of which the CHADS(2) (congestive heart failure, hypertension, age ≥ 75 y, diabetes, stroke [doubled]) score is the most widely studied. We evaluated whether the CHADS(2) score was adequate for TE risk stratification while assessing cardiac risk in patients with AF revascularized with coronary artery stents.
  
  
  METHODS
  We reviewed 604 consecutive patients with AF treated with at least one stent between 2001 and 2008 in relation to TE risk using CHADS(2) score. We stratified our patients with a CHADS(2) score ≤ 1 as low-moderate thromboembolic risk (group 1: n = 193, 32%) and > 1 as high risk (and, hence, requiring anticoagulation; group 2: n = 411, 68%). We determined the benefits and/or risks of oral anticoagulation (OAC) therapy in both cohorts.
  
  
  RESULTS
  Completed follow-up was achieved in 90.4% (mean 642.2 days). Group 1 event-free survival was better than group 2 (major adverse cardiovascular events [MACEs], log-rank test P = .03; and death, log-rank test P = .03). In group 1, event-free survival was better on OAC vs non-OAC use (death 5% vs 15%, P = .04; MACE 10% vs 26%, P < .01) with a trend for more major hemorrhages (12% vs 4%, P = .08). Stroke rate was 4.1% per 100 patient-years in patients without OAC therapy and 1.38% in patients on OAC therapy. Group 2 had a lower incidence of death (20% vs 34%, P < .01) and MACE (26% vs 43%, P < .01) among those on OAC therapy on discharge, with a higher incidence of major hemorrhages (18% vs 8%, P < .01).
  
  
  CONCLUSIONS
  In a population of patients with AF revascularized with stents, even those with CHADS(2) ≤ 1 should be regarded as being at high risk. OAC should be considered as thromboprophylaxis in patients with AF revascularized with coronary stents.
authors.affiliation: Department of Cardiology, Hospital General Universitario de Alicante, Alicante, Spain.
authors.forename: Juan M
authors.initials: JM
authors.lastname: Ruiz-Nodar
authors.affiliation: Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Marín
authors.affiliation: Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Sergio
authors.initials: S
authors.lastname: Manzano-Fernández
authors.affiliation: Department of Cardiology, Hospital General Universitario de Alicante, Alicante, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Valencia-Martín
authors.affiliation: Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
authors.forename: José A
authors.initials: JA
authors.lastname: Hurtado
authors.affiliation: Department of Hematology, Hospital Morales Meseguer, Murcia, Spain.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Roldán
authors.affiliation: Department of Cardiology, Hospital General Universitario de Alicante, Alicante, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Pineda
authors.affiliation: Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Pinar
authors.affiliation: Department of Cardiology, Hospital General Universitario de Alicante, Alicante, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Sogorb
authors.affiliation: Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Mariano
authors.initials: M
authors.lastname: Valdés
authors.affiliation: University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, England. Electronic address: g.y.h.lip@bham.ac.uk.
authors.forename: Gregory Y H
authors.initials: GYH
authors.lastname: Lip
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D001281:Atrial Fibrillation / Q000150:complications / Q000628:therapy*; D048909:Diabetes Complications / Q000150:complications; D005260:Female; D006333:Heart Failure / Q000150:complications; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D015607:Stents; D020521:Stroke / Q000209:etiology*; D016896:Treatment Outcome