Management of antithrombotic
therapy in patients with
atrial fibrillation (AF) and coronary stenting remains challenging, and there is a need for efficient tools to predict their risk of different types of cardiovascular events and death. Several scores exist such as the CHA2DS2-VASc score, the Global Registry of Acute Coronary Events (GRACE) score, the Synergy between
Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score, the Anatomical and Clinical Syntax II Score and the Reduction of
Atherothrombosis for Continued Health score. These 5 scores were investigated in patients with AF with coronary stenting with the aim of determining which was most predictive for
stroke/thromboembolic (TE) events, nonlethal coronary events, all-cause mortality, and
major adverse cardiac events (
MACE). Among 845 patients with AF with coronary stenting seen from 2000 to 2014, 440 (52%) were admitted for
acute coronary syndrome and 405 (48%) for elective
percutaneous coronary intervention. The rate of cardiovascular complication was at 14.1% per year, and nonlethal coronary events were the most frequent complications with a yearly rate of 6.5%. CHA2DS2-VASc score was the best predictor of
stroke/TE events with a c-statistic of 0.604 (95% CI 0.567 to 0.639) and a best cut-off point of 5. SYNTAX score was better to predict nonlethal coronary events and
MACE with c-statistics of 0.634 (95% CI 0.598 to 0.669) and 0.612 (95% CI 0.575 to 0.647), respectively, with a best cut-off point of 9. GRACE score appeared to be the best to predict all-cause mortality with a c-statistic of 0.682 (95% CI 0.646 to 0.717) and a best cut-off point of 153. In conclusions, among validated scores, none is currently robust enough to simultaneously predict
stroke/TE events, nonlethal coronary events, death, and
MACE in patients with AF with
stents. The CHA2DS2-VASc score remained the best score to assess
stroke/TE risk, as was the SYNTAX score for nonlethal coronary events and
MACE, and finally, the GRACE score for all-cause mortality in this study population.