Stroke Risk Stratification in Patients With Postoperative Atrial Fibrillation After Coronary Artery Bypass Grafting.

Content Provider	Europe PMC
Author	Taha, Amar Nielsen, Susanne J. Franzén, Stefan Rezk, Mary Ahlsson, Anders Friberg, Leif Björck, Staffan Jeppsson, Anders Bergfeldt, Lennart
Abstract	BackgroundThe CHA2DS2‐VASc (congestive heart failure, hypertension, age ≥75 years, diabetes, previous stroke or TIA [transient ischemic attack], vascular disease, age 65 to 74 years, sex category female; 2 indicates 2 points, otherwise 1 point) scoring system is recommended to guide decisions on oral anticoagulation therapy for stroke prevention in patients with nonsurgery atrial fibrillation. A score ≥1 in men and ≥2 in women, corresponding to an annual stroke risk exceeding 1%, warrants long‐term oral anticoagulation provided the bleeding risk is acceptable. However, in patients with new‐onset postoperative atrial fibrillation, the optimal risk stratification method is unknown. The aim of this study was therefore to evaluate the CHA2DS2‐VASc scoring system for estimating the 1‐year ischemic stroke risk in patients with new‐onset postoperative atrial fibrillation after coronary artery bypass grafting.Methods and ResultsAll patients with new‐onset postoperative atrial fibrillation and without oral anticoagulation after first‐time isolated coronary artery bypass grafting performed in Sweden during 2007 to 2017 were eligible for this registry‐based observational cohort study. The 1‐year ischemic stroke rate at each step of the CHA2DS2‐VASc score was estimated using a Kaplan‐Meier estimator. Of the 6368 patients included (mean age, 69.9 years; 81% men), >97% were treated with antiplatelet drugs. There were 147 ischemic strokes during the first year of follow‐up. The ischemic stroke rate at 1 year was 0.3%, 0.7%, and 1.5% in patients with CHA2DS2‐VASc scores of 1, 2, and 3, respectively, and ≥2.3% in patients with a score ≥4. A sensitivity analysis, with the inclusion of patients on anticoagulants, was performed and supported the primary results.ConclusionsPatients with new‐onset atrial fibrillation after coronary artery bypass grafting and a CHA2DS2‐VASc score <3 have such a low 1‐year risk for ischemic stroke that oral anticoagulation therapy should probably be avoided.
Page Count	9
Journal	Journal of the American Heart Association
Volume Number	11
PubMed Central reference number	PMC9238552
Issue Number	10
PubMed reference number	35574947
e-ISSN	20479980
DOI	10.1161/jaha.121.024703
Language	English
Publisher	John Wiley and Sons Inc.
Publisher Date	2022-05-16
Publisher Place	Hoboken
Access Restriction	Open
Rights License	This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. © 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
Subject Keyword	CHA2DS2‐VASc coronary artery bypass grafting new‐onset postoperative atrial fibrillation Cardiovascular Surgery Atrial Fibrillation
Content Type	Text
Resource Type	Article
Subject	Cardiology and Cardiovascular Medicine