Refining Prediction of Atrial Fibrillation-Related Stroke Using the P2-CHA2DS2-VASc Score: The Atherosclerosis Risk in Communities (ARIC) Study and Multi-Ethnic Study of Atherosclerosis (MESA)

Background: In people with atrial fibrillation (AF), periods of sinus rhythm present an opportunity to detect pro-thrombotic atrial remodeling through measurement of P-wave indices (PWIs)—prolonged P-wave duration, abnormal P-wave axis, advanced inter-atrial block, and abnormal P-wave terminal force in lead V1. We hypothesized that addition of PWIs to the CHA2DS2-VASc score would improve its ability to predict AF-related ischemic stroke. Methods: We included 2229 Atherosclerosis Risk in Communities (ARIC) study and 700 Multi-Ethnic Study of Atherosclerosis (MESA) participants with incident AF who were not on anticoagulants within 1 year of AF diagnosis. PWIs were obtained from study visit ECGs before development of AF. AF was ascertained using study visit ECGs and hospital records. Ischemic stroke cases were based on physician adjudication of hospital records. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) of PWIs for ischemic stroke. Improve...