From the Guidelines
No, coronary artery disease (CAD) that has been stented does not count as a point in the CHA₂DS₂-VASc score. The "V" in CHA₂DS₂-VASc stands for vascular disease, but this specifically refers to peripheral artery disease, previous myocardial infarction, or aortic plaque - not coronary stenting alone 1. For a patient to receive a point for vascular disease in this scoring system, they must have had a prior myocardial infarction, peripheral arterial disease, or complex aortic plaque. A coronary stent placement without a history of myocardial infarction would not qualify for a point. This distinction is important because the CHA₂DS₂-VASc score is used to estimate stroke risk in patients with atrial fibrillation and helps determine whether anticoagulation therapy is warranted. Accurately calculating this score ensures appropriate stroke prevention strategies are implemented for patients with atrial fibrillation.
Some key points to consider when evaluating the CHA₂DS₂-VASc score include:
- The score is used to estimate stroke risk in patients with atrial fibrillation
- The "V" in CHA₂DS₂-VASc refers to vascular disease, which includes peripheral artery disease, previous myocardial infarction, or aortic plaque
- Coronary stenting alone does not qualify as a point for vascular disease in the CHA₂DS₂-VASc score
- Accurate calculation of the CHA₂DS₂-VASc score is crucial for determining the need for anticoagulation therapy in patients with atrial fibrillation, as seen in the 2019 AHA/ACC/HRS guideline update 1.
It's also worth noting that the management of patients with atrial fibrillation and coronary artery disease is complex and requires careful consideration of the risks and benefits of different treatment strategies, including anticoagulation therapy and antiplatelet therapy 1. However, the specific question of whether CAD that has been stented counts as a point in the CHA₂DS₂-VASc score can be answered clearly based on the current guidelines and evidence.
From the Research
CAD and CHADS2 VASc Score
- The CHADS2 VASc score is used to risk stratify patients with atrial fibrillation (AF) for stroke risk 2.
- Known coronary artery disease (CAD) is a variable included in the CHA2DS2-VASc score.
- However, the provided studies do not directly address whether CAD that has been stented counts towards the CHADS2 VASc score.
Stented CAD and Stroke Risk
- Incidental coronary artery calcification (CAC) without known CAD is associated with an increased risk of stroke and mortality in patients with AF, independent of CHA2DS2-VASc variables 2.
- The presence of CAC is a marker of atherosclerotic disease and may indicate an increased risk of cardiovascular events.
- However, it is unclear whether stented CAD would be considered equivalent to known CAD in the CHADS2 VASc score.
Antithrombotic Therapy in AF Patients with CAD
- Antithrombotic therapy is crucial in patients with AF and CAD to reduce the risk of stroke and cardiovascular events 3, 4, 5, 6.
- The choice of antithrombotic therapy depends on the individual patient's risk factors, including the presence of CAD and the risk of bleeding.
- Dual antiplatelet therapy (DAPT) and oral anticoagulation therapy are commonly used in patients with AF and CAD, but the optimal duration and combination of therapy are still being studied.