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

Alejandro Isidoro Pérez Cabeza, Rafael Bravo Marques, Pedro Antonio Chinchurreta Capote, Francisco Ruiz Mateas, Christina Fanola, Gabriel Rosas Cervantes, Jose Antonio González Correa, Almudena Valle Alberca, Fidel Mesa Prado, Sergio López Tejero, Christian Thomas Ruff

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: 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 vitamin K antagonists (VKA). Hypothesis: Our objective was to determine the ability to predict cardiovascular events according to the TIMI-AF score in a real-world population. Methods: Retrospective observational study of VKA-naïve patients with AF was 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). Results: The study population comprised of 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 CHA2DS2VASc (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 SAMeTT2R2 (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). Conclusions: 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 CHA2DS2VASc, HAS-BLED, and SAMeTT2R2.

Original languageEnglish (US)
Pages (from-to)1252-1258
Number of pages7
JournalClinical Cardiology
Volume41
Issue number9
DOIs
StatePublished - Sep 1 2018

Fingerprint

Vitamin K
Atrial Fibrillation
Outpatients
Anticoagulants
Stroke
Hemorrhage
Ambulatory Care Facilities
Embolism
Cardiology
ROC Curve
Spain
Population
Area Under Curve
Observational Studies
Retrospective Studies
Myocardial Infarction
Mortality

Keywords

  • TIMI-AF score
  • anticoagulants
  • atrial fibrillation
  • cardiovascular prognosis

PubMed: MeSH publication types

  • Journal Article
  • Observational Study

Cite this

Pérez Cabeza, A. I., Bravo Marques, R., Chinchurreta Capote, P. A., Ruiz Mateas, F., Fanola, C., Rosas Cervantes, G., ... Ruff, C. T. (2018). TIMI-AF score and cardiovascular events in vitamin K antagonists-naïve outpatients with atrial fibrillation. Clinical Cardiology, 41(9), 1252-1258. https://doi.org/10.1002/clc.23035

TIMI-AF score and cardiovascular events in vitamin K antagonists-naïve outpatients with atrial fibrillation. / Pérez Cabeza, Alejandro Isidoro; Bravo Marques, Rafael; Chinchurreta Capote, Pedro Antonio; Ruiz Mateas, Francisco; Fanola, Christina; Rosas Cervantes, Gabriel; González Correa, Jose Antonio; Valle Alberca, Almudena; Mesa Prado, Fidel; López Tejero, Sergio; Ruff, Christian Thomas.

In: Clinical Cardiology, Vol. 41, No. 9, 01.09.2018, p. 1252-1258.

Research output: Contribution to journalArticle

Pérez Cabeza, AI, Bravo Marques, R, Chinchurreta Capote, PA, Ruiz Mateas, F, Fanola, C, Rosas Cervantes, G, González Correa, JA, Valle Alberca, A, Mesa Prado, F, López Tejero, S & Ruff, CT 2018, 'TIMI-AF score and cardiovascular events in vitamin K antagonists-naïve outpatients with atrial fibrillation', Clinical Cardiology, vol. 41, no. 9, pp. 1252-1258. https://doi.org/10.1002/clc.23035
Pérez Cabeza AI, Bravo Marques R, Chinchurreta Capote PA, Ruiz Mateas F, Fanola C, Rosas Cervantes G et al. TIMI-AF score and cardiovascular events in vitamin K antagonists-naïve outpatients with atrial fibrillation. Clinical Cardiology. 2018 Sep 1;41(9):1252-1258. https://doi.org/10.1002/clc.23035
Pérez Cabeza, Alejandro Isidoro ; Bravo Marques, Rafael ; Chinchurreta Capote, Pedro Antonio ; Ruiz Mateas, Francisco ; Fanola, Christina ; Rosas Cervantes, Gabriel ; González Correa, Jose Antonio ; Valle Alberca, Almudena ; Mesa Prado, Fidel ; López Tejero, Sergio ; Ruff, Christian Thomas. / TIMI-AF score and cardiovascular events in vitamin K antagonists-naïve outpatients with atrial fibrillation. In: Clinical Cardiology. 2018 ; Vol. 41, No. 9. pp. 1252-1258.
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T1 - TIMI-AF score and cardiovascular events in vitamin K antagonists-naïve outpatients with atrial fibrillation

AU - Pérez Cabeza, Alejandro Isidoro

AU - Bravo Marques, Rafael

AU - Chinchurreta Capote, Pedro Antonio

AU - Ruiz Mateas, Francisco

AU - Fanola, Christina

AU - Rosas Cervantes, Gabriel

AU - González Correa, Jose Antonio

AU - Valle Alberca, Almudena

AU - Mesa Prado, Fidel

AU - López Tejero, Sergio

AU - Ruff, Christian Thomas

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N2 - Background: 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 vitamin K antagonists (VKA). Hypothesis: Our objective was to determine the ability to predict cardiovascular events according to the TIMI-AF score in a real-world population. Methods: Retrospective observational study of VKA-naïve patients with AF was 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). Results: The study population comprised of 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 CHA2DS2VASc (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 SAMeTT2R2 (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). Conclusions: 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 CHA2DS2VASc, HAS-BLED, and SAMeTT2R2.

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