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

doi:10.1016/j.hrthm.2014.08.003

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

Heart Rhythm. 2014 Nov;11(11):1941-7. doi: 10.1016/j.hrthm.2014.08.003. Epub 2014 Aug 5.

Authors

Affiliations

¹ Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.
² Department of Medicine, Taipei City Hospital, Taipei, Taiwan.
³ Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Public Health and School of Medicine, National Yang-Ming University, Taipei, Taiwan.
⁴ Institute of Public Health and School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
⁵ Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
⁶ Division of Cardiology, Department of Medicine, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan.
⁷ University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom.
⁸ Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan. Electronic address: [email protected].

PMID: 25101483
DOI: 10.1016/j.hrthm.2014.08.003

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.

Keywords: Atrial fibrillation; CHA(2)DS(2)-VASc score; Gender; Myocardial infarction; Subclinical atherosclerosis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Atrial Fibrillation / complications*
Atrial Fibrillation / epidemiology
Case-Control Studies
Female
Humans
Incidence
Male
Middle Aged
Myocardial Infarction / epidemiology
Myocardial Infarction / etiology*
Retrospective Studies
Risk Assessment
Risk Factors
Severity of Illness Index*
Taiwan / epidemiology