R 2 -CHA 2 DS 2 -VASc Score for Cardiovascular Event Prediction After Bioprosthetic Valve Replacement　- Subanalysis From the BPV-AF Registry.

Background: There are few studies evaluating the prognostic prediction method in atrial fibrillation (AF) patients after bioprosthetic valve (BPV) replacement. The R ₂ -CHA ₂ DS ₂ -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 R ₂ -CHA ₂ DS ₂ -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 R ₂ -CHA ₂ DS ₂ -VASc score was 5.7±1.8. Low (scores 0-1), moderate (scores 2-4), and high (scores 5-11) R ₂ -CHA ₂ DS ₂ -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 R ₂ -CHA ₂ DS ₂ -VASc score group (log rank test; P<0.001). Multivariate Cox proportional hazards regression analysis revealed that the R ₂ -CHA ₂ DS ₂ -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 R ₂ -CHA ₂ DS ₂ -VASc score is useful for CV risk stratification in AF patients after BPV replacement.
Competing Interests: H.T. has received consultancy fees from AstraZeneca PLC and Ono Pharmaceutical Co., Ltd. K.A. has received remuneration from Japan Lifeline Co., Ltd, Terumo Corporation, and Medtronic Japan Co., Ltd. M.I. has received consultancy fees from Abbott Medical Japan LLC, and remuneration from Edwards Lifesciences Corporation. T.S. has received remuneration from Medtronic Japan Co., Ltd. K.M. has received scholarship funds or donations from Edwards Lifesciences Corporation, Terumo Co., Ltd, and Japan Lifeline Co., Ltd. K.M. has received scholarship funds or donations from Edwards Lifesciences Corporation, Terumo Co., Ltd., and Japan Lifeline Co., Ltd. K.T. is a member of Circulation Reports’ Editorial Team, and has received remuneration from Amgen K.K., Bayer Yakuhin Ltd, Daiichi Sankyo Co., Ltd, Kowa Pharmaceutical Co. Ltd, Novartis Pharma K.K., Otsuka Pharmaceutical Co., Ltd, and Pfizer Japan Inc.; research funding from AMI Co., Ltd, Bayer Yakuhin Ltd, Bristol-Myers Squibb K.K., EA Pharma Co., Ltd, and Mochida Pharmaceutical Co., Ltd; scholarship funding from AMI Co., Ltd, Bayer Yakuhin Ltd, Nippon Boehringer Ingelheim Co., Ltd, Chugai Pharmaceutical Co., Ltd, Daiichi Sankyo Co., Ltd, Edwards Lifesciences Corporation, Johnson & Johnson K.K., Ono Pharmaceutical Co., Ltd, Otsuka Pharmaceutical Co., Ltd, and Takeda Pharmaceutical Co., Ltd; and is affiliated with the endowed department sponsored by Abbott Japan Co., Ltd, Boston Scientific Japan K.K., Fides-one Inc., GM Medical Co., Ltd, ITI Co., Ltd, Kaneka Medix Co., Ltd, Nipro Corporation, Terumo Co., Ltd, Abbott Medical Co., Ltd, Cardinal Health Japan LLC, Fukuda Denshi Co., Ltd, Japan Lifeline Co., Ltd, Medical 3 Appliance Co., Ltd, and Medtronic Japan Co., Ltd. Y. Sakata has received remuneration from Daiichi Sankyo Co., Ltd, and Nippon Boehringer Ingelheim Co., Ltd; and scholarship funding from Nippon Boehringer Ingelheim Co., Ltd, Bayer Yakuhin Ltd, and Daiichi Sankyo Co., Ltd. K.S. is an employee of Daiichi Sankyo Co., Ltd. K.N. has received research funding from Philips Japan Ltd, Terumo Co., Ltd, TEPCO Power Grid Inc., and Asahi Kasei Pharma Co. C.I. has received remuneration and research funding from Daiichi Sankyo Co., Ltd. Y.F. has received remuneration from Daiichi Sankyo Co., Ltd, and Bayer Yakuhin Ltd. All other authors have no conflicts of interest to disclosure.
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