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TIMI-AF score and cardiovascular events in vitamin K antagonists (VKA)-naïve outpatients with atrial fibrillation.

Research paper by Alejandro Isidoro AI Pérez Cabeza, Rafael R Bravo Marques, Pedro Antonio PA Chinchurreta Capote, Francisco F Ruiz Mateas, Christina L CL Fanola, Gabriel G Rosas Cervantes, Jose Antonio JA González Correa, Almudena A Valle Alberca, Fidel F Mesa Prado, Sergio S López Tejero, Christian Thomas CT Ruff

Indexed on: 01 Aug '18Published on: 01 Aug '18Published in: Clinical Cardiology



Abstract

The TIMI-AF score predicts poor outcomes in patients with atrial fibrillation (AF) and guides selection of anticoagulant therapy by identifying clinical benefit of direct oral anticoagulants (DOACs) or VKA. Our objective was to determine the ability to predict cardiovascular events according to the TIMI-AF score in a real-world population. Retrospective observational study of VKA-naïve patients with AF seen at a cardiology outpatient clinic in Spain between November 2012 and August 2014. We recorded adverse events (myocardial infarction, systemic embolism or stroke, major bleeding, and death). The study population comprised 426 patients (50.7% men, mean age, 69 ± 14 years). The TIMI-AF score identified 372 patients (87.3%) with a low risk, 50 patients (11.7%) with an intermediate risk and 4 patients (0.9%) with a high risk. After a mean follow-up of 423.4 ± 200.1 days, 37 patients (9%) experienced an adverse event. Patients with a TIMI-AF score ≥7 had a poorer cardiovascular prognosis (HR, 6.1; 95%CI, 3.2-11.7; p<0.001). The area under the ROC curve of TIMI-AF was 0.755 (95%CI, 0.669-0.840; p<0.001), which was greater than that of CHA DS VASc (0.641; 95%CI, 0.559-0.724; p=0.004), HAS-BLED (0.666; 95%CI, 0.578-0.755; p<0.001) and SAMeTT R (0.529; 95%CI, 0.422-0.636; p=0.565). Similar results were obtained in relation to the net clinical outcome (life-threatening bleeding, disabling stroke, or all-cause mortality). The TIMI-AF risk score can identify patients who are at greater risk of cardiovascular events and a poor net clinical outcome with a better diagnostic yield than CHA DS VASc, HAS-BLED and SAMeTT R . This article is protected by copyright. All rights reserved.

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