Applying the CHA(2)DS(2)-VASc score to predict the risk of future acute coronary syndrome in patients receiving catheter ablation for atrial fibrillation

OBJECTIVE: It remains unknown whether catheter ablation for atrial fibrillation (AF) reduces future acute coronary syndrome (ACS) risk or whether the CHA(2)DS(2)-VASc score has a role in predicting this risk. We aimed to compare very long-term risk of ACS between patients who received catheter ablation to AF or antiarrhythmic medications and controls without AF. METHODS: Propensity scores were calculated for each patient and used to assemble a cohort of 787 patients undergoing AF ablation in 2003–2012. Patients were compared to an equal number of AF patients treated with antiarrhythmic medications and a control group without AF. Patients with previous coronary events were excluded. The primary endpoint was ACS occurrence. RESULTS: Baseline clinical characteristics were comparable. After a mean 9.1 ± 3.2-year follow-up, the ablation group had lower incidence of new onset ACS than the medication and non-AF control groups (annual incidence: 0.15%. 0.78%, and 0.35%; with 2.67, 4.16, and 10.44 cases/1000 person-years, respectively; P < 0.001). After adjusting for multiple confounders, the ablation group had lower future ACS risk than the medication (hazard ratio [HR]: 0.20, 95% confidence interval [CI]: 0.13–0.30) and control groups (HR: 0.30, 95% CI: 0.20–0.45). The CHA(2)DS(2)-VASc score was a strong predictor of ACS (HR: 1.61, 95% CI: 1.47–1.76; AUC: 85.9%, 95% CI: 78.5–93.2%). A baseline CHA(2)DS(2)-VASc score ≥ 4 predicted future ACS (positive predictive rate: 14.3%). CONCLUSIONS: This study suggested that catheter ablation for AF may be beneficial to reduce future ACS risk in AF patients, and a high baseline CHA(2)DS(2)-VASc score can predict future acute coronary events.