Abstract 17014: The Impact of Risk Score (CHADS2 versus CHADS2-Vasc) on Long-term Outcomes After Atrial Fibrillation Ablation

Abstract

Background: Risk stratification tools are needed to better select candidates for catheter ablation of atrial fibrillation (AF). Both the CHADS2 and CHADS2-VASC scores have utility in predicting AF-related outcomes and guiding anticoagulation treatment. We sought to determine if these risk scores predict long-term outcomes after AF ablation and if one risk score provides comparative superior performance. Methods: CHADS2 and CHADS2-VASC scores were calculated in 2179 AF ablation patients enrolled into Intermountain Heart Collaborative Study. CHADS2 and CHADS2-VASC were categorized by recursive partitioning categories as CHADS2: 0-1, 2-4, and >4 and CHADS2-VASC: 0-2, 2-5, >5. Patient outcomes were analyzed over 5 years for AF/Aflutter recurrence and MACE (death, stroke, heart failure hospitalization and AF/Aflutter recurrence). Results: Average age was 65.7±10.5 years and 61.1% were male. Both scores incrementally predicted risk of AF recurrence, stroke, heart failure, and death at 5 years (Figure). Increasing CHADS2 (hazard ratio [HR] =1.19, p<0.001) and CHADS2-VASC (HR=1.15, p<0.0001) scores were both associated with AF/Aflutter recurrence. Results were similar for MACE: with increasing CHADS2 (HR=1.20, p<0.0001) and CHADS2-VASC (HR=1.15, p<0.0001) scores associated with risk. When CHADS2 and CHADS2-VASC were modeled simultaneously, only CHADS-VASC significantly predicted AF recurrence (HR=1.13, p=0.001) and MACE (HR=1.13, p=0.001). Conclusion: Both the CHADS2 and CHADS2-VASC scores were excellent in stratifying patients for 5-year outcomes after AF ablation. However, the CHADS2-VASC score was superior to CHADS2 when accounting for all baseline variables for predicting both AF recurrence and AF-related morbidities.