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KMID : 0882420150880060672
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Korean Journal of Medicine
2015 Volume.88 No. 6 p.672 ~ p.679
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Predictors of Progression and Prognosis of Paroxysmal Atrial Fibrillation
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Kim Ji-Eun
Lee Ki-Hong
Lee Seung-Hun
Park Hyuk-Jin
Kim Hyun-Kuk
Kim Sung-Soo
Jeong Hae-Chang
Cho Jae-Yeong
Park Keun-Ho
Sim Doo-Sun
Yoon Hyun-Joo
Yoon Nam-Sik
Park Hyung-Wook
Kim Kye-Hun
Hong Young-Joon
Kim Ju-Han
Ahn Young-Keun
Jeong Myung-Ho
Cho Jeong-Gwan
Park Jong-Chun
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Abstract
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Background/Aims: Significant numbers of patients with paroxysmal atrial fibrillation (AF) proceed to persistent AF and have poor clinical outcomes despite the use of antiarrhythmic agents or direct-current cardioversion. We compared the CHADS2, CHA2DS2-VASc, and HATCH scoring systems to predict AF progression and prognosis and identify the most useful scoring system in Korea.
Methods: A total of 559 consecutive patients with paroxysmal symptomatic AF were analyzed. The progression of AF and clinical outcomes were determined after at least 1 year of follow-up. Clinical outcomes were defined as the composite of death, hospitalization due to heart failure, and new-onset stroke. Each score was calculated, and its predictive accuracy for AF progression and prognosis was compared.
Results: A total of 147 patients with paroxysmal AF (26.3%) proceeded to persistent AF. The HATCH score (area under the curve [AUC], 0.601; p < 0.001) was the most powerful scoring system for the prediction of AF progression, although the CHADS2 (AUC, 0.565) and CHA2DS2-VASc (AUC, 0.558) were also useful. The CHA2DS2-VASc (AUC, 0.734; p < 0.001) was the most powerful scoring system for the prediction of clinical outcomes with a more significant linear correlation (0: 3.3% vs. 1: 6.3% vs. 2: 15.4% vs. 3: 20.7% vs. 4: 18.0% vs. 5: 53.6% vs. ≥ 6: 55.6%, linear p < 0.001) than the CHADS2 (AUC, 0.720) and HATCH scoring systems (AUC, 0.723).
Conclusions: Although the CHADS2, CHA2DS2-VASc, and HATCH scoring systems were useful predictors of progression from paroxysmal to persistent AF, the CHA2DS2-VASc score was the most useful and accurate for the prediction of clinical outcomes.
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KEYWORD
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Atrial fibrillation, Paroxysmal, Progression, Prognosis
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