Dual antithrombotic treatment in chronic coronary syndrome : European Society of Cardiology criteria vs. CHADS-P2A2RC score
Würtz, Morten ; Olesen, Kevin Kris Warnakula ; Mortensen, Martin Bødtker ; Eikelboom, John W. ; Mohammad, Moman Aladdin LU ; Erlinge, David LU
; Kristensen, Steen Dalby
and Maeng, Michael
(2022)
In European Heart Journal
43(10).
p.996-1004
- Abstract
AIMS: According to the 2019 European Society of Cardiology (ESC) guidelines on chronic coronary syndromes (CCS), adding a P2Y12 inhibitor or rivaroxaban to aspirin should be considered in high-risk patients. We estimated the proportion of patients eligible for treatment with the ESC criteria and examined if a recently validated risk score (CHADS-P2A2RC) could improve risk prediction. METHODS AND RESULTS: We included 61 338 CCS patients undergoing first-time coronary angiography in Western Denmark (2003-16) and classified them according to the ESC criteria and the CHADS-P2A2RC score. The ESC criteria identified 33.9% as high risk, 53.3% as moderate risk, and 12.8% as low risk. The CHADS-P2A2RC score identified 24.9% as high risk (≥4... (More)
AIMS: According to the 2019 European Society of Cardiology (ESC) guidelines on chronic coronary syndromes (CCS), adding a P2Y12 inhibitor or rivaroxaban to aspirin should be considered in high-risk patients. We estimated the proportion of patients eligible for treatment with the ESC criteria and examined if a recently validated risk score (CHADS-P2A2RC) could improve risk prediction. METHODS AND RESULTS: We included 61 338 CCS patients undergoing first-time coronary angiography in Western Denmark (2003-16) and classified them according to the ESC criteria and the CHADS-P2A2RC score. The ESC criteria identified 33.9% as high risk, 53.3% as moderate risk, and 12.8% as low risk. The CHADS-P2A2RC score identified 24.9% as high risk (≥4 points), 48.1% as moderate risk (2-3 points), and 27.0% as low risk (≤1 points). Major adverse cardiovascular events per 100 person-years were 4.8 [95% confidence interval (CI) 4.6-5.0] in patients considered high risk with both schemes, 2.1 (95% CI 2.0-2.2) in patients considered high risk with the ESC but low-to-moderate risk with the CHADS-P2A2RC criteria, 3.8 (95% CI 3.6-4.1) in patients considered low-to-moderate risk with the ESC but high risk with the CHADS-P2A2RC criteria, and 1.5 (95% CI 1.5-1.6) in patients considered low-to-moderate risk with both schemes. The CHADS-P2A2RC score enabled correct downward risk reclassification of 5161 patients (8%) without events, yielding an improved specificity of 9.7%, a loss of sensitivity of 4.4%, and an overall net reclassification index of 0.053. CONCLUSION: Based on the 2019 ESC guidelines, dual antithrombotic treatment should be considered in one-third of CCS patients. The CHADS-P2A2RC score improved risk classification and may particularly identify low-risk patients with limited benefit from treatment.
(Less)
- author
- Würtz, Morten
; Olesen, Kevin Kris Warnakula
; Mortensen, Martin Bødtker
; Eikelboom, John W.
; Mohammad, Moman Aladdin
LU
; Erlinge, David
LU
; Kristensen, Steen Dalby
and Maeng, Michael
- publishing date
- 2022-03-07
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Aspirin, Chronic coronary syndrome, Coronary artery disease, Myocardial infarction, Platelet inhibitors, Rivaroxaban
- in
- European Heart Journal
- volume
- 43
- issue
- 10
- pages
- 9 pages
- publisher
- Oxford University Press
- external identifiers
-
- pmid:34871376
- scopus:85125882927
- ISSN
- 1522-9645
- DOI
- 10.1093/eurheartj/ehab785
- language
- English
- LU publication?
- no
- id
- b256acc4-0e12-4314-9b2f-1f76416864ee
- date added to LUP
- 2022-04-20 16:43:02
- date last changed
- 2024-04-08 01:25:20
@article{b256acc4-0e12-4314-9b2f-1f76416864ee,
abstract = {{<p>AIMS: According to the 2019 European Society of Cardiology (ESC) guidelines on chronic coronary syndromes (CCS), adding a P2Y12 inhibitor or rivaroxaban to aspirin should be considered in high-risk patients. We estimated the proportion of patients eligible for treatment with the ESC criteria and examined if a recently validated risk score (CHADS-P2A2RC) could improve risk prediction. METHODS AND RESULTS: We included 61 338 CCS patients undergoing first-time coronary angiography in Western Denmark (2003-16) and classified them according to the ESC criteria and the CHADS-P2A2RC score. The ESC criteria identified 33.9% as high risk, 53.3% as moderate risk, and 12.8% as low risk. The CHADS-P2A2RC score identified 24.9% as high risk (≥4 points), 48.1% as moderate risk (2-3 points), and 27.0% as low risk (≤1 points). Major adverse cardiovascular events per 100 person-years were 4.8 [95% confidence interval (CI) 4.6-5.0] in patients considered high risk with both schemes, 2.1 (95% CI 2.0-2.2) in patients considered high risk with the ESC but low-to-moderate risk with the CHADS-P2A2RC criteria, 3.8 (95% CI 3.6-4.1) in patients considered low-to-moderate risk with the ESC but high risk with the CHADS-P2A2RC criteria, and 1.5 (95% CI 1.5-1.6) in patients considered low-to-moderate risk with both schemes. The CHADS-P2A2RC score enabled correct downward risk reclassification of 5161 patients (8%) without events, yielding an improved specificity of 9.7%, a loss of sensitivity of 4.4%, and an overall net reclassification index of 0.053. CONCLUSION: Based on the 2019 ESC guidelines, dual antithrombotic treatment should be considered in one-third of CCS patients. The CHADS-P2A2RC score improved risk classification and may particularly identify low-risk patients with limited benefit from treatment.</p>}},
author = {{Würtz, Morten and Olesen, Kevin Kris Warnakula and Mortensen, Martin Bødtker and Eikelboom, John W. and Mohammad, Moman Aladdin and Erlinge, David and Kristensen, Steen Dalby and Maeng, Michael}},
issn = {{1522-9645}},
keywords = {{Aspirin; Chronic coronary syndrome; Coronary artery disease; Myocardial infarction; Platelet inhibitors; Rivaroxaban}},
language = {{eng}},
month = {{03}},
number = {{10}},
pages = {{996--1004}},
publisher = {{Oxford University Press}},
series = {{European Heart Journal}},
title = {{Dual antithrombotic treatment in chronic coronary syndrome : European Society of Cardiology criteria vs. CHADS-P2A2RC score}},
url = {{http://dx.doi.org/10.1093/eurheartj/ehab785}},
doi = {{10.1093/eurheartj/ehab785}},
volume = {{43}},
year = {{2022}},
}