Evidence map›Paper›PMID 26471883›Full record

Observational studyInternal and emergency medicine2016

Cardiovascular risk stratification in patients with non-valvular atrial fibrillation: the 2MACE score.

Daniele Pastori, Alessio Farcomeni, Daniela Poli, Emilia Antonucci, Francesco Angelico, Maria Del Ben, Roberto Cangemi, Gaetano Tanzilli, Gregory Yoke Hong Lip, Pasquale Pignatelli and 1 more

Registry-linked trialAbstract readObservational Study
PubMed Publisher
In one paragraph

Observational study in Internal and emergency medicine, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01882114 (Study of Atherosclerotic Risk Factors and Oxidative Stress in Atrial Fibrillation. Relation to Cardiovascular Events), which is not on this map. Cited by 18 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
18citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01882114 unknown statusnot on this map

Study of Atherosclerotic Risk Factors and Oxidative Stress in Atrial Fibrillation. Relation to Cardiovascular Events

TypeobservationalSponsorUniversity of Roma La SapienzaRan2007 to 2020Enrolled3,000ConditionsAtrial Fibrillation, Metabolic Syndrome, Oxidative Stress, Atherosclerosis
3 · Its place in the literature

Who cites it

18 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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  3. Observational
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  8. Review
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  11. Observational
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Daniele PastoriI Clinica Medica, Atherothrombosis Center, Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
Alessio FarcomeniDepartment of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy.
Daniela PoliThrombosis Centre, Department of Heart and Vessels, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
Emilia AntonucciDepartment of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Francesco AngelicoDepartment of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy.
Maria Del BenI Clinica Medica, Atherothrombosis Center, Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
Roberto CangemiI Clinica Medica, Atherothrombosis Center, Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
Gaetano TanzilliDepartment of the Heart and Great Vessels Attilio Reale, "Sapienza" University of Rome, Rome, Italy.
Gregory Yoke Hong LipCentre for Cardiovascular Sciences, City Hospital, University of Birmingham, Birmingham, UK.
Pasquale PignatelliI Clinica Medica, Atherothrombosis Center, Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
Francesco VioliI Clinica Medica, Atherothrombosis Center, Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy. francesco.violi@uniroma1.it.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Recent findings suggest that patients with non-valvular atrial fibrillation (AF), in addition to having a high risk for ischemic stroke, are also at risk for myocardial infarction (MI). The aim of the study was to combine factors predicting Major Adverse Cardiovascular Events (MACE) in AF patients, including fatal/nonfatal MI, cardiac revascularization, and cardiovascular death, into a simple risk score. Predictors of MACE were obtained from a prospective observational cohort study, including 1019 AF patients taking vitamin K antagonists from the Atherothrombosis Center, of Sapienza University of Rome. Thus, we derived the 2MACE score [2 points for Metabolic Syndrome and Age ≥75, 1 point for MI/revascularization, Congestive heart failure (ejection fraction ≤40 %), thrombo-Embolism (stroke/transient ischemic attack)], ranging from 0 to 7 points. To evaluate the 2MACE score, we included an external validation cohort of 1089 anticoagulated AF patients from the Thrombosis Centre of Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy. At follow-up, 111 AF patients in the internal and 68 in the external cohort experienced a MACE. The 2MACE score showed a good ability in discriminating AF patients experiencing MACE both in the internal derivation cohort, with a c-index of 0.79 [95 % Confidence Interval (CI) 0.71-0.90, p < 0.001] and in the external validation cohort (c-index 0.66, 95 % CI 0.60-0.73, p < 0.001). The overall Hazard Ratio (HR) was 1.61 (95 % CI 1.40-1.85, p < 0.001) for each additional point. A 2MACE score ≥3 had the best combination of specificity and sensitivity, with an HR of 3.92 (95 % CI 2.41-6.40, p < 0.001). The new simple 2MACE score may help identifying AF patients at risk for cardiovascular events.

Indexed as

AgedAged, 80 and overAtrial FibrillationCohort StudiesFemaleHumansMaleMiddle AgedMyocardial InfarctionMyocardial RevascularizationRisk FactorsSensitivity and SpecificityAtrial fibrillationCardiovascular eventsMetabolic syndromeMyocardial infarctionRisk score

Identifiers

PMID26471883

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.