Prognostic role of the 2MACE score in older patients with atrial fibrillation

Atrial fibrillation (AF) is the most common arrhythmia in the elderly and is associated with an increased risk of cardiovascular events (CVE); indeed, a percentage of patients develop CVE during oral anticoagulation. The 2MACE score is a clinical score used to predict the risk of MACE in patients with AF, but not in elderly patients with AF. Therefore, the purpose of this work is to evaluate the possible predictive value of the 2MACE score on MACE onset, in a cohort of elderly patients with non-valvular AF and several comorbidities for long-term follow-up. 1005 elderly with non-valvular AF were enrolled (76.4 ± 6.1 years; 291 on VKAs and 714 on DOACs) and stratified according to the median value of 2MACE score. MACE (non-fatal ischemic stroke, non-fatal myocardial infarction, and cardiovascular death) and all-cause mortality occurrence were evaluated during a mean follow-up of 6.2 years. In this multicenter retrospective observational study, a 2MACE score ≥ 4 pt (taken as a dichotomous value) (HR 4.38, 95% CI 3.46-5.55; p < 0.0001) was associated with a 4.3-fold increased risk of MACE, with modest discriminatory ability (AUC: 0.65; standard error: 0.018; 95% CI, 0.62-0.69). Furthermore, the presence of MMSE score < 24 pt (HR 1.27, 95% CI 1.03-1.56, p = 0.026) was associated with a 27% increased risk of MACE. In contrast, DOACs and SGLT2-inhibitor were associated with a 55% (HR 0.45, 95% CI 0.36-0.55, p < 0.0001) and 46% (HR 0.54, 95% CI 0.41-0.71, p < 0.0001) lower risk of MACE, respectively. Elderly patients with non-valvular AF whot exhibit a 2MACE score ≥ 4 pt show a higher risk of MACE and all-cause mortality.