ABSTRACT
BACKGROUND AND AIMS: Complex aortic atheroma (CAA) is a common cause of acute brain ischemia (BI), including ischemic stroke (IS) and transient ischemic attack (TIA), and is associated with recurrence. The CHA2DS2-VASc score is a useful tool for predicting stroke in patients with atrial fibrillation (AF), and can also predict cardiovascular events in other populations, including non-AF populations. The ADAM-C score is a new risk score for predicting the diagnostic yield of transesophageal echocardiography (TEE) after BI. We aimed to evaluate the ability of CHA2DS2-VASc and ADAM-C scores to predict CAA after BI. METHODS: This prospective, multicenter, observational study included 1479 patients aged over 18 years who were hospitalized for BI. CAA was defined as the presence of one or more of the following criteria: thrombus, ulcerated plaque, or plaque thickening ≥ 4 mm. RESULTS: CAA was diagnosed in 216 patients (14.6%). CHA2DS2-VASc and ADAM-C scores were significantly higher in the CAA group versus the non-CAA group (P < .0001 for both). The CHA2DS2-VASc and ADAM-C scores appear to be good predictors of CAA (AUC 0.699 [0.635, 0.761] and 0.759 [0.702, 0.814], respectively). The sensitivity, specificity, predictive positive value (PPV), and negative predictive value (NPV) of the scores for detecting CAA were 94%, 22%, 17%, and 96%, respectively, for a CHA2DS2-VASc score < 2, and 90%, 46%, 22%, and 96%, respectively, for an ADAM-C score < 3 CONCLUSIONS: CHA2DS2-VASc and ADAM-C scores are able to predict CAA after BI. CHA2DS2-VASc < 2 and ADAM-C < 3 both have an interesting NPV of 96%.
Subject(s)
Atrial Fibrillation , Brain Ischemia , Plaque, Atherosclerotic , Stroke , Adult , Brain Ischemia/complications , Brain Ischemia/diagnostic imaging , Humans , Middle Aged , Plaque, Atherosclerotic/diagnosis , Plaque, Atherosclerotic/diagnostic imaging , Prospective Studies , Risk Assessment , Risk FactorsABSTRACT
AIMS: In patients with acute myocardial infarction (MI), mortality can be predicted by risk scoring systems, but the impact of therapy recommended by guidelines is poorly documented. The aim of this study was to determine, taking into account the patient's condition at admission, to what extent the degree of guideline compliance influences the 1-year survival of patients admitted for acute MI. METHODS AND RESULTS: A 6-month registry was carried out in a geographically limited area, prospectively including all patients with acute MI. A risk score based on initial presentation, and a compliance index based on patient characteristics, type of MI, in-hospital management (including revascularization strategies and use of recommended drugs) were established. Patients were clinically followed at 1 year. A total of 754 patients, 333 ST elevation MI and 421 non-ST elevation MI, were included. The median compliance index (percentage of optimal compliance with guidelines) was 0.66 (95% CI 0.5;8.3). One-year mortality rate was 11.5%. By logistic regression, three variables were independently related to mortality: type of MI [OR=2.6 (1.5;4.3)], risk score [OR=2.4 (1.9;3.1) per additional 10%], and compliance index [OR=0.8 (0.7;0.9) per additional 10%]. CONCLUSION: A clear relationship between the extent of guideline implementation, and 1-year mortality was shown and this relationship remained strong after stratification on the risk score at admission and the type of MI. These data emphasize the need for thorough implementation of guidelines to improve the outcome of patients suffering from acute MI.