CHA2DS2-VASc score and the risk of acute myocardial infarction in patients with non-valvular atrial fibrillation treated with direct oral anticoagulants

Background: Patients with atrial fibrillation are at increased cardiovascular risk. The CHA2DS2-VASc score has been used to predict the annual thromboembolic risk in patients with non-valvular atrial fibrillation. Our objective was to evaluate the association between The CHA2DS2-VASc score and the risk of acute myocardial infarction in patients with atrial fibrillation treated with the new direct oral anticoagulants (DOACs).

Methods: The study was based on the Clalit Health Services database. Included were patients with non-valvular AF treated with DOACs. Patients were stratified into 4 groups according to the CHA2DS2-VASc score (1-2, 3-4, 5-6, and 7-9). The primary endpoint was the occurrence of acute myocardial infarction.

Results: During 59,041 person-years of follow-up, there were 1,253 (5.9%) incidents of Acute myocardial infarction. Higher CHA2DS2-VASc score was associated with a significantly increased risk of myocardial infarction (7.8, 14.9, 23.9, and 35.3 cases per 1000 person-years, for patients with CHA2DS2-VASc score of 1-2, 3-4, 5-6, and 7-9, respectively; P < .001). This association remained significant even following multivariate analysis. Using the low CHA2DS2-VASc score group as a reference demonstrated a direct association between the CHA2DS2-VASc score and acute myocardial infarction risk ( HR=1.92 95%CI 1.35-2.73, 3.10 95%CI 2.20-4.36, 4.57 95%CI 3.22-6.48, in patients with CHA2DS2-VASc score 3-4, 5-6, and 7-9, respectively; P < .001). Each 1 point increase in the CHA2DS2-VASc score was associated with a 27% increased risk of myocardial infarction.

Conclusions: Among patients with non-valvular AF treated with DOACs, the CHA2DS2-VASc score is associated with an increased risk of acute myocardial infarction.