title: Cardiovascular risk stratification in patients with non-valvular atrial fibrillation: the 2MACE score.
abstract: Recent findings suggest that patients with non-valvular atrial fibrillation (AF), in addition to having a high risk for ischemic stroke, are also at risk for myocardial infarction (MI). The aim of the study was to combine factors predicting Major Adverse Cardiovascular Events (MACE) in AF patients, including fatal/nonfatal MI, cardiac revascularization, and cardiovascular death, into a simple risk score. Predictors of MACE were obtained from a prospective observational cohort study, including 1019 AF patients taking vitamin K antagonists from the Atherothrombosis Center, of Sapienza University of Rome. Thus, we derived the 2MACE score [2 points for Metabolic Syndrome and Age ≥75, 1 point for MI/revascularization, Congestive heart failure (ejection fraction ≤40 %), thrombo-Embolism (stroke/transient ischemic attack)], ranging from 0 to 7 points. To evaluate the 2MACE score, we included an external validation cohort of 1089 anticoagulated AF patients from the Thrombosis Centre of Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy. At follow-up, 111 AF patients in the internal and 68 in the external cohort experienced a MACE. The 2MACE score showed a good ability in discriminating AF patients experiencing MACE both in the internal derivation cohort, with a c-index of 0.79 [95 % Confidence Interval (CI) 0.71-0.90, p < 0.001] and in the external validation cohort (c-index 0.66, 95 % CI 0.60-0.73, p < 0.001). The overall Hazard Ratio (HR) was 1.61 (95 % CI 1.40-1.85, p < 0.001) for each additional point. A 2MACE score ≥3 had the best combination of specificity and sensitivity, with an HR of 3.92 (95 % CI 2.41-6.40, p < 0.001). The new simple 2MACE score may help identifying AF patients at risk for cardiovascular events.
authors.affiliation: I Clinica Medica, Atherothrombosis Center, Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Pastori
authors.affiliation: Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Farcomeni
authors.affiliation: Thrombosis Centre, Department of Heart and Vessels, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Poli
authors.affiliation: Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
authors.forename: Emilia
authors.initials: E
authors.lastname: Antonucci
authors.affiliation: Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Angelico
authors.affiliation: I Clinica Medica, Atherothrombosis Center, Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Del Ben
authors.affiliation: I Clinica Medica, Atherothrombosis Center, Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Cangemi
authors.affiliation: Department of the Heart and Great Vessels Attilio Reale, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Tanzilli
authors.affiliation: Centre for Cardiovascular Sciences, City Hospital, University of Birmingham, Birmingham, UK.
authors.forename: Gregory Yoke Hong
authors.initials: GY
authors.lastname: Lip
authors.affiliation: I Clinica Medica, Atherothrombosis Center, Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Pignatelli
authors.affiliation: I Clinica Medica, Atherothrombosis Center, Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy. francesco.violi@uniroma1.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Violi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications* / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D009204:Myocardial Revascularization; D012307:Risk Factors; D012680:Sensitivity and Specificity
keywords: Atrial fibrillation; Cardiovascular events; Metabolic syndrome; Myocardial infarction; Risk score