Acute myocardial infarction in patients with atrial fibrillation with a CHA2DS2-VASc score of 0 or 1: a nationwide cohort study

Tze Fan Chao, Yen Chang Huang, Chia Jen Liu, Su Jung Chen, Kang Ling Wang, Yenn Jiang Lin, Shih Lin Chang, Li Wei Lo, Yu Feng Hu, Ta Chuan Tuan, Tzeng Ji Chen, Ming Hsiung Hsieh, Gregory Y H Lip, Shih Ann Chen

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37 Citations (Scopus)

Abstract

BACKGROUND: The risk of acute myocardial infarction (AMI) in patients with atrial fibrillation (AF) with a CHA2DS2-VASc score of 0 (for men) or 1 (for women) has not been previously investigated.

OBJECTIVE: The objective of the present study was to compare the risk of AMI in AF and non-AF subjects with a low (0 or 1) CHA2DS2-VASc score.

METHODS: By using the National Health Insurance Research Database in Taiwan, we identified 7254 men with AF (with a CHA2DS2-VASc score of 0) and 4860 women with AF (with a CHA2DS2-VASc score of 1). For each study patient, 1 age-, sex-, and CHA2DS2-VASc score-matched subject without AF was randomly selected to constitute the control group (n = 12,114). The clinical end point was the occurrence of AMI.

RESULTS: During a mean follow-up period of 5.7 ± 3.6 years, 258 patients (1.1%) suffered an AMI, with an annual incidence of 0.29% and 0.10% for patients with and without AF. AF was an independent risk factor of AMI, with an adjusted hazard ratio (HR) of 2.93 (95% confidence interval 2.21-3.87; P <.001). The risk of AMI was higher in men with AF than in women with AF, with a hazard ratio of 2.24 (95% confidence interval 1.61-3.11; P <.001) after adjustment for age and other comorbidities.

CONCLUSION: In patients with a CHA2DS2-VASc score of 0 or 1, AF was an independent risk factor of AMI. The risk of AMI was higher in men with AF than in women with AF. Cardiovascular risk prevention should be performed as part of the holistic management of AF to minimize the risks of AMI associated with AF.

Original languageEnglish
Pages (from-to)1941-1947
Number of pages7
JournalHeart Rhythm
Volume11
Issue number11
DOIs
Publication statusPublished - Nov 1 2014

Keywords

  • Atrial fibrillation
  • CHA(2)DS(2)-VASc score
  • Gender
  • Myocardial infarction
  • Subclinical atherosclerosis

ASJC Scopus subject areas

  • Medicine(all)

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