title: Carotid plaque detection improves the predictive value of CHA2DS2-VASc score in patients with non-valvular atrial fibrillation: The ARAPACIS Study.
abstract: OBJECTIVE
  Vascular disease (VD), as assessed by history of myocardial infarction or peripheral artery disease or aortic plaque, increases stroke risk in atrial fibrillation (AF), and is a component of risk assessment using the CHA2DS2-VASc score. We investigated if systemic atherosclerosis as detected by ultrasound carotid plaque (CP) could improve the predictive value of the CHA2DS2-VASc score.
  
  
  METHODS
  We analysed data from the ARAPACIS study, an observational study including 2027 Italian patients with non-valvular AF, in whom CP was detected using Doppler Ultrasonography.
  
  
  RESULTS
  VD was reported in 351 (17.3%) patients while CP was detected in 16.6% patients. Adding CP to the VD definition leaded to higher VD prevalence (30.9%). During a median [IQR] follow-up time of 36months, 56 (2.8%) stroke/TIA events were recorded. Survival analysis showed that conventional VD alone did not increase the risk of stroke (Log-Rank: 0.009, p=0.924), while addition of CP to conventional VD was significantly associated to an increased risk of stroke (LR: 5.730, p=0.017). Cox regression analysis showed that VD+CP was independently associated with stroke (HR: 1.78, 95% CI: 1.05-3.01, p=0.0318). Reclassification analysis showed that VD+CP allowed a significant risk reclassification when compared to VD alone in predicting stroke at 36months (NRI: 0.192, 95% CI: 0.028-0.323, p=0.032).
  
  
  CONCLUSIONS
  In non-valvular AF patients the addition of ultrasound detection of carotid plaque to conventional VD significantly increases the predictive value of CHA2DS2-VASc score for stroke.
authors.affiliation: Clinica Medica, Atherothrombosis Center, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Basili
authors.affiliation: Clinica Medica, Atherothrombosis Center, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Loffredo
authors.affiliation: Clinica Medica, Atherothrombosis Center, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Pastori
authors.affiliation: Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom.
authors.forename: Marco
authors.initials: M
authors.lastname: Proietti
authors.affiliation: Department of Public Health and Infections Disease, Sapienza University of Rome, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Farcomeni
authors.affiliation: Department of Public Health and Infections Disease, Sapienza University of Rome, Italy.
authors.forename: Anna Rita
authors.initials: AR
authors.lastname: Vestri
authors.affiliation: Clinica Medica, Atherothrombosis Center, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Pignatelli
authors.affiliation: Department of Medicine and Aging, University of Chieti "G. d'Annunzio", Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Davì
authors.affiliation: Division of Cardiology, University of Colorado School of Medicine and CPC Clinical Research, Aurora, CO, USA.
authors.forename: William R
authors.initials: WR
authors.lastname: Hiatt
authors.affiliation: Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom.
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
authors.affiliation: First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy.
authors.forename: Gino R
authors.initials: GR
authors.lastname: Corazza
authors.affiliation: Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Perticone
authors.affiliation: Clinica Medica, Atherothrombosis Center, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Italy. Electronic address: francesco.violi@uniroma1.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Violi
authors.affiliation: See Appendix A.
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index; D001281:Atrial Fibrillation / Q000150:complications* / Q000175:diagnosis; D002340:Carotid Artery Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D058226:Plaque, Atherosclerotic / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D018608:Ultrasonography, Doppler / Q000379:methods*
keywords: Atherosclerosis; Atrial fibrillation; CHA(2)DS(2)-VASc score; Carotid plaque; Stroke; Vascular disease