Abstract
CHA2DS2VASc score have been suggested to predict death in patients with Atrial Fibrillation (AF). In acute myocardial infarction (AMI), silent AF is common and associated with poor prognosis. In patients with AMI, we aimed to assess the CHA2DS2VASc score of patients with silent or symptomatic AF. 849 consecutive AMI were prospectively analyzed by continuous ECG monitoring (CEM) <48 hours after admission. Silent AF was defined as asymptomatic episodes lasting >30 sec. Symptomatic AF was defined as any AF occurring on ECG during the hospital stay, resulting in clinical symptoms or need for urgent cardioversion. 135 (16%) developed silent AF and 45(5%) had symptomatic AF. Compared with the no AF group, patients with silent AF were markedly older (80 vs. 62 years; p<0.001), more frequently women and less smoker. Patients with silent and symptomatic AF, had higher CHA2DS2VASc score than patients without AF (5 and 5 vs 3, p<0.001). CHA2DS2VASc score was similar in patients with silent and symptomatic AF (p=0.550). Mortality was higher in silent AF and symptomatic AF than in patients without AF ((10.4% and 17.8% vs 1.3%, p<0.001). CHA2DS2VASc score was associated with mortality in patients with AF, but not in patients without AF (OR[95%CI]: 1.32[1.02-1.72], and 1.22[0.88- 1.71], respectively). High CHA2DS2VASc (≥4) and GRACE (≥153) scores independently stratified mortality. By multivariate analysis, high CHA2DS2VASc score was an independent explanatory variable for death (OR[95%CI): 3.89[1.08- 13.93]), beyond GRACE risk score (OR[95%CI]: 9.77[2.74-34.80]). Patients with silent AF have level of CHA2DS2VASc risk similar to patients with symptomatic AF. A high CHA2DS2VASc score is associated with mortality, even when adjusted for GRACE risk score. These data suggest that CHA2DS2VASc score could improve risk stratification after AMI. The author hereby declares no conflict of interest
Published Version
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