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2013 ; 6
(3
): 896
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Performance of the Cockcroft-Gault, MDRD and CKD-EPI Formulae in Non-Valvular
Atrial Fibrillation: Which one Should be Used for Risk Stratification?
#MMPMID28496890
Barra S
; Providência R
; Faustino C
; Paiva L
; Fernandes A
; Leitão Marques A
J Atr Fibrillation
2013[Oct]; 6
(3
): 896
PMID28496890
show ga
Background: Renal dysfunction is a strong predictor of adverse events in patients
with atrial fibrillation (AF). The Cokcroft-Gault, Modification of Diet in Renal
Disease (MDRD) and Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI)
equations are available for estimating the glomerular filtration rate (GFR). No
comparisons between these equations have yet been performed in patients with
non-valvular AF concerning their mid-term prognostic performance. Methods:
Cross-sectional study of 555 consecutive patients with non-valvular AF undergoing
transesophageal echocardiogram. We tested the prognostic performance of the
aforementioned GFR estimation formulae, namely their ability to predict all-cause
mortality (primary endpoint) and major cardiac adverse or ischemic
cerebrovascular events (secondary endpoints) during an average follow-up of 24
months. Results: Regarding the primary endpoint, Cockcroft-Gault
(AUC=0.749±0.028) was superior to both MDRD (AUC=0.624±0.039) and CKD-EPI
(AUC=0.641±0.034) [p<0.001 both comparisons] while CKD-EPI was superior to MDRD
(p=0.011). Cockcroft-Gault was marginally superior to both MDRD (AUC=0.673±0.049
vs. AUC=0.586±0.054, p=0.041) and CKD-EPI (AUC=0.673±0.049 vs. AUC=0.604±0.054,
p=0.063) in the prediction of ischemic cerebrovascular events, while no
difference was found between CKD-EPI and MDRD. Concerning AUC for prediction of
MACE, Cockcroft-Gault was superior to MDRD (p=0.009) and CKD-EPI (p=0.012), while
CKD-EPI was similar to MDRD (p=0.215). Multivariate predictive models
consistently included Cockcroft-Gault formula along with CHADS(2), excluding the
other two equations. Measures of reclassification revealed a significant
improvement in risk stratification for all studied endpoints with Cockcroft-Gault
instead of CKD-EPI. Conclusions: In patients with non-valvular AF, the
Cockcroft-Gault more appropriately classified individuals with respect to risk of
all-cause mortality, ischaemic cerebrovascular event and major adverse cardiac
event.