Validity of HELT-E₂S₂ Score in Predicting Ischemic Stroke in Japanese Patients With Non-Valvular Atrial Fibrillation With Cardiac Implantable Electronic Devices

Abstract

Background: The HELT-E₂S₂score, a novel risk stratification system, was developed to determine the incidence of ischemic stroke in Japanese patients with non-valvular atrial fibrillation (NVAF). It has been suggested that the HELT-E₂S₂score is more useful than the CHADS₂and CHA₂DS₂-VASc scores for Japanese patients with NVAF. This study determined the incidence of ischemic stroke in patients with NVAF and cardiac implantable electronic devices (CIEDs) and assessed the validity of the HELT-E₂S₂score in this population.

Methods and Results: We retrospectively analyzed the database of the CIED clinic of Chiba University Hospital and investigated the incidence of ischemic stroke according to the HELT-E₂S₂score. Of the 730 consecutive patients who were followed-up at the CIED clinic, those without NVAF were excluded, leaving 362 patients in this study (mean [±SD] follow-up period, 64±48 months; mean age, 73±16 years; 65% male). The mean CHADS₂and CHA₂DS₂-VASc scores were 1.8±1.2 and 2.8±1.6 points, respectively. During follow-up, 31 (8.6%) patients experienced ischemic stroke. The c-statistic for the HELT-E₂S₂score was 0.719 (95% confidence interval [CI] 0.657–0.795), which was higher than the c-statistics for the CHADS₂(0.704; 95% CI 0.647–0.768; P=0.025) and CHA₂DS₂-VASc (0.700; 95% CI:0.621–0.747; P=0.0097) scores.

Conclusions: Risk stratification for ischemic stroke using the HELT-E₂S₂score is valid in Japanese patients with NVAF and CIEDs.