Stroke and Systemic Thromboembolism according to CHA 2 DS 2 -VASc Score in Contemporary Korean Patients with Atrial Fibrillation
10.3349/ymj.2022.63.4.317
- Author:
Kyung Bae LEE
1
;
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
Author Information
1. Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
- Publication Type:Original Article
- From:Yonsei Medical Journal
2022;63(4):317-324
- CountryRepublic of Korea
- Language:English
-
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.
