Relationship between vascular calcification assessed by chest CT and CHA2DS2-VASc score in patients with atrial fibrillation receiving oral anticoagulant.

BACKGROUND

The CHA2DS2-VASc [congestive heart failure, hypertension, age ≥75 years (2 points), diabetes, previous stroke/transient ischemic attack/arterial thromboembolism (2 points), vascular disease, age 65-74 years, and female sex] score is a well-established tool for stratifying thromboembolic risk in atrial fibrillation (AF) patients and identifying those suitable for initiation of oral anticoagulant (OAC) therapy. Patients with AF requiring anticoagulation are often at high risk for vascular calcification (VC). However, the relationship between the CHA2DS2-VASc score and VC, particularly in patients receiving OACs, remains poorly understood. This study aimed to evaluate the burden of VC according to the baseline CHA2DS2-VASc score and to explore its relationship with OAC use.

METHODS

A total of 1,288 AF patients were categorized based on the presence or absence of VC assessed by computed tomography (CT). Clinical characteristics, CHA2DS2-VASc scores, and major adverse cardiovascular events (MACEs) were compared between these groups. The differential effects of warfarin and direct oral anticoagulants (DOACs) on VC burden were further evaluated.

RESULTS

A positive correlation was observed between the CHA2DS2-VASc score and the prevalence and severity of VC. Crucially, there was a greater burden of calcification in patients with a low CHA2DS2-VASc score of the rivaroxaban group (P=0.020) and the warfarin group (P=0.021) than in the non-anticoagulant group. Further, we found that patients in the rivaroxaban group had more severe calcification in the thoracic aorta (P=0.044), and the warfarin group's calcification burden was greatest in the left subclavian artery (P=0.027) and coronary arteries (P=0.001). The multivariate Cox regression analysis indicated that MACEs were nearly threefold more frequent in the high CHA2DS2-VASc score group compared to the low score group (P=0.005).

CONCLUSIONS

In AF patients receiving OACs, higher CHA2DS2-VASc scores are associated with an increased prevalence and severity of VC, as well as a higher frequency of MACEs.