R₂-CHA₂DS₂-VASc Score for Cardiovascular Event Prediction After Bioprosthetic Valve Replacement　― Subanalysis From the BPV-AF Registry ―

抄録

Background: There are few studies evaluating the prognostic prediction method in atrial fibrillation (AF) patients after bioprosthetic valve (BPV) replacement. The R₂-CHA₂DS₂-VASc score is increasingly used for the prediction of cardiovascular (CV) events in patients with AF, device implantation, and acute coronary syndrome. We aimed to evaluate the predictive value of the R₂-CHA₂DS₂-VASc score for future CV events in AF patients after BPV replacement.

Methods and Results: The BPV-AF, an observational, multicenter, prospective registry, enrolled AF patients who underwent BPV replacement. The primary outcome measure was a composite of stroke, systemic embolism, CV events including heart failure requiring hospitalization, and cardiac death. A total of 766 patients was included in the analysis. The mean R₂-CHA₂DS₂-VASc score was 5.7±1.8. Low (scores 0–1), moderate (scores 2–4), and high (scores 5–11) R₂-CHA₂DS₂-VASc score groups consisted of 12 (1.6%), 178 (23.2%), and 576 (75.2%) patients, respectively. The median follow-up period was 491 (interquartile range 393–561) days. Kaplan-Meier analysis showed a higher incidence of the composite CV events in the high R₂-CHA₂DS₂-VASc score group (log rank test; P<0.001). Multivariate Cox proportional hazards regression analysis revealed that the R₂-CHA₂DS₂-VASc score as a continuous variable was an independent predictor of composite CV outcomes (hazard ratio 1.36; 95% confidence interval 1.18–1.55; P<0.001).

Conclusions: The R₂-CHA₂DS₂-VASc score is useful for CV risk stratification in AF patients after BPV replacement.