Reclassification Of Cha2ds2-Vasc Thromboembolic Risk By Coronary Calcifications On Cardiac Computed Tomography In Atrial Fibrillation

Background: CHA 2 DS 2 -VASc is the most widely used thromboembolism risk score in patients with atrial fibrillation (AF). Cardiac computed tomography (CCT) routinely performed before or after pulmonary vein isolation (PVI) for AF rhythm control offers the opportunity to detect coronary calcifications (CAC) and this vascular pathology. We evaluated the frequency of CAC and the extent it affects the CHA 2 DS 2 -VASc and decision for anticoagulation for AF patients undergoing PVI. Methods: In 2014, 772 consecutive patients underwent PVI at Cleveland clinic, and 621 patients who had CCT within 1-year before or after PVI were studied. Relationships between CAC recorded as a binary variable with clinical characteristics and reclassification of CHA 2 DS 2 -VASc was analyzed. Results: Mean age was 63.1±9.8 years, 163 (26.2%) were females, 322 (51.9%) had paroxysmal AF and 264 (42.5%) having prior PVI. CAC was identified on CCT in 388 (62.5%) patients. Age was the only factor independently associated with CAC, odds ratio 1.02 (95% confidence interval 1.01-1.04), P=0.004. CAC increased the CHA 2 DS 2 -VASc in 306 (49.3%) patients, and the mean from 2.0±1.5 to 2.5±1.4 (Table). Using gender-specific cutpoints from the latest guidelines, 71 (11.4%) had CHA 2 DS 2 -VASc going from 0 to 1 in men or 1 to 2 in women (where anticoagulation may be considered), and 113 (18.2%) had CHA 2 DS 2 -VASc going from 1 to 2 in men or to 3 in women (where long-term anticoagulation is indicated). Conclusion: Almost two-thirds of patients undergoing PVI have CAC detectable on CCT, and after incorporating this information, long-term anticoagulation may or would be indicated in an additional 30% of the cohort. By assessing vascular pathology, CCT can play an important screening role for thromboembolic risk in AF patients incremental to clinical risk factors.