title: Comparison between CHA2DS2-VASc and the new R2CHADS2 and ATRIA scores at predicting thromboembolic event in non-anticoagulated and anticoagulated patients with non-valvular atrial fibrillation.
abstract: BACKGROUND
  Accurate risk stratification is considered the first and most important step in the management of patients with non-valvular atrial fibrillation (NVAF). We compared the performance of the widely used CHA2DS2-VASc and the recently developed R2CHADS2 and ATRIA scores, for predicting thromboembolic (TE) event in either non-anticoagulated or anticoagulated patients with NVAF.
  
  
  METHODS
  The non-anticoagulated cohort was comprised of 154 patients, whereas 911 patients formed the cohort of patients on vitamin-K-antagonist. The scores were computed using the criteria mentioned in their developmental cohorts. Measures of performance for the risk scores were evaluated at predicting TE event.
  
  
  RESULTS
  In the non-anticoagulated cohort, 9 TE events occurred during 11 ± 2.7 months. CHA2DS2-VASc showed significant association with TE occurrence: hazard ratio (HR) = 1.58 (95 % confidence interval [95 % IC] 1.01-2.46), but R2CHADS2 and ATRIA did not (HR = 1.23 (95 % CI 0.86-1.77) and 1.20 (95 % CI 0.93-1.56), respectively. In the anticoagulated cohort, after 10 ± 3 months of follow up, 18 TE events were developed. In that cohort, the three scores showed similar association with TE risk: HR = 1.49 (95 % CI 1.13-1.97), 1.41 (95 % CI 1.13-1.77) and 1.37 (95 % CI 1.12-1.66) for CHA2DS2-VASc, R2CHADS2 and ATRIA, respectively. In both cohorts, no TE event occurred in patients classified in the low risk category according to CHA2DS2-VASc or R2CHADS2.
  
  
  CONCLUSIONS
  In this study of NVAF patients, CHA2DS2-VASc has better association with TE events than the new R2CHADS2 and ATRIA risk scores in the non-anticoagulated cohort. CHA2DS2-VASc and R2CHADS2 can identify patients at truly low risk regardless of the anticoagulation status.
authors.affiliation: Cardiology Department, University Clinical Hospital, A choupana s/n, 15706, Santiago de Compostela, Spain. drrami2012@hotmail.com.
authors.forename: Rami Riziq-Yousef
authors.initials: RR
authors.lastname: Abumuaileq
authors.affiliation: Cardiology Department, University Clinical Hospital, A choupana s/n, 15706, Santiago de Compostela, Spain. eabuassi@gmail.com.
authors.forename: Emad
authors.initials: E
authors.lastname: Abu-Assi
authors.affiliation: Cardiology Department, University Clinical Hospital, A choupana s/n, 15706, Santiago de Compostela, Spain. andrea.lopez86@hotmail.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: López-López
authors.affiliation: Cardiology Department, University Clinical Hospital, A choupana s/n, 15706, Santiago de Compostela, Spain. raposeiras26@hotmail.com.
authors.forename: Sergio
authors.initials: S
authors.lastname: Raposeiras-Roubin
authors.affiliation: Cardiology Department, University Clinical Hospital, A choupana s/n, 15706, Santiago de Compostela, Spain. moirmanero@gmail.com.
authors.forename: Moisés
authors.initials: M
authors.lastname: Rodríguez-Mañero
authors.affiliation: Cardiology Department, University Clinical Hospital, A choupana s/n, 15706, Santiago de Compostela, Spain. luismartinezsande@gmail.com.
authors.forename: Luis
authors.initials: L
authors.lastname: Martínez-Sande
authors.affiliation: Cardiology Department, University Clinical Hospital, A choupana s/n, 15706, Santiago de Compostela, Spain. javiergarciaseara@yahoo.es.
authors.forename: Javier
authors.initials: J
authors.lastname: García-Seara
authors.affiliation: Cardiology Department, University Clinical Hospital, A choupana s/n, 15706, Santiago de Compostela, Spain. xalberte@yahoo.es.
authors.forename: Xesús Alberte
authors.initials: XA
authors.lastname: Fernandez-López
authors.affiliation: Cardiology Department, University Clinical Hospital, A choupana s/n, 15706, Santiago de Compostela, Spain. carlospenagil@hotmail.com.
authors.forename: Carlos
authors.initials: C
authors.lastname: Peña-Gil
authors.affiliation: Cardiology Department, University Clinical Hospital, A choupana s/n, 15706, Santiago de Compostela, Spain. jose.ramon.gonzalez.juanatey@sergas.es.
authors.forename: Jose Ramón
authors.initials: JR
authors.lastname: González-Juanatey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications* / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D013923:Thromboembolism / Q000209:etiology* / Q000517:prevention & control
chemical_list: D000925:Anticoagulants