Validating the predictive ability of the 2MACE score for major adverse cardiovascular events in patients with atrial fibrillation: results from phase II/III of the GLORIA-AF registry
Authors: Ding Wern Yew , Fawzy Ameenathul Mazaya , Romiti Giulio Francesco , Proietti Marco , Pastori Daniele , Huisman Menno V. , Lip Gregory Y. H. ,   on behalf of the GLORIA-AF Investigators, Abban Dzifa Wosornu , Abdul Nasser , Abud Atilio Marcelo , Adams Fran , Addala Srinivas , Adragão Pedro , Ageno Walter , Aggarwal Rajesh , Agosti Sergio , Agostoni Piergiuseppe , Aguilar Francisco , Linares Julio Aguilar , Aguinaga Luis , Ahmed Jameel , Aiello Allessandro , Ainsworth Paul , Aiub Jorge Roberto , Al-Dallow Raed , Alderson Lisa , Velasco Jorge Antonio Aldrete , Alexopoulos Dimitrios , Manterola Fernando Alfonso , Aliyar Pareed , Alonso David , da Costa Fernando Augusto Alves , Amado José , Amara Walid , Amelot Mathieu , Amjadi Nima , Ammirati Fabrizio , Andrade Marianna , Andrawis Nabil , Annoni Giorgio , Ansalone Gerardo , Ariani M. Kevin , Arias Juan Carlos , Armero Sébastien , Arora Chander , Aslam Muhammad Shakil , Asselman M. , Audouin Philippe , Augenbraun Charles , Aydin S. , Ayryanova Ivaneta , Aziz Emad , Backes Luciano Marcelo , Badings E. , Bagni Ermentina , Baker Seth H. , Bala Richard , Baldi Antonio , Bando Shigenobu , Banerjee Subhash , Bank Alan , Esquivias Gonzalo Barón , Barr Craig , Bartlett Maria , Kes Vanja Basic , Baula Giovanni , Behrens Steffen , Bell Alan , Benedetti Raffaella , Mazuecos Juan Benezet , Benhalima Bouziane , Bergler-Klein Jutta , Berneau Jean-Baptiste , Berrospi Percy , Berti Sergio , Berz Andrea , Best Elizabeth , Bettencourt Paulo , Betzu Robert , Bhagwat Ravi , Bhatta Luna , Biscione Francesco , Bisignani Giovanni , Black Toby , Bloch Michael J. , Bloom Stephen , Blumberg Edwin , Bo Mario , Bøhmer Ellen , Bollmann Andreas , Bongiorni Maria Grazia , Boriani Giuseppe , Boswijk D. J. , Bott Jochen , Bottacchi Edo , Kalan Marica Bracic , Bradman Drew , Brautigam Donald , Breton Nicolas , Brouwers P. J. A. M. , Browne Kevin , Cortada Jordi Bruguera , Bruni A. , Brunschwig Claude , Buathier Hervé , Buhl Aurélie , Bullinga John , Cabrera Jose Walter , Caccavo Alberto , Cai Shanglang , Caine Sarah , Calò Leonardo , Calvi Valeria , Sánchez Mauricio Camarillo , Candeias Rui , Capuano Vincenzo , Capucci Alessandro , Caputo Ronald , Rizo Tatiana Cárdenas , Cardona Francisco , da Costa Darrieux Francisco Carlos , Vera Yan Carlos Duarte , Carolei Antonio , Carreño Susana , Carvalho Paula , Cary Susanna , Casu Gavino , Cavallini Claudio , Cayla Guillaume , Celentano Aldo , Cha Tae-Joon , Cha Kwang Soo , Chae Jei Keon , Chalamidas Kathrine , Challappa Krishnan , Chand Sunil Prakash , Chandrashekar Harinath , Chartier Ludovic , Chatterjee Kausik , Ayala Carlos Antero Chavez , Cheema Aamir , Cheema Amjad , Chen Lin , Chen Shih-Ann , Chen Jyh Hong , Chiang Fu-Tien , Chiarella Francesco , Chih-Chan Lin , Cho Yong Keun , Choi Jong-Il , Choi Dong Ju , Chouinard Guy , Chow Danny Hoi-Fan , Chrysos Dimitrios , Chumakova Galina , Valenzuela Eduardo Julián José Roberto Chuquiu , Nica Nicoleta Cindea , Cislowski David J. , Clay Anthony , Clifford Piers , Cohen Andrew , Cohen Michael , Cohen Serge , Colivicchi Furio , Collins Ronan , Colonna Paolo , Compton Steve , Connolly Derek , Conti Alberto , Buenostro Gabriel Contreras , Coodley Gregg , Cooper Martin , Coronel Julian , Corso Giovanni , Sales Juan Cosín , Cottin Yves , Covalesky John , Cracan Aurel , Crea Filippo , Crean Peter , Crenshaw James , Cullen Tina , Darius Harald , Dary Patrick , Dascotte Olivier , Dauber Ira , Davalos Vicente , Davies Ruth , Davis Gershan , Davy Jean-Marc , Dayer Mark , De Biasio Marzia , De Bonis Silvana , De Caterina Raffaele , De Franceschi Teresiano , de Groot J. R. , De Horta José , De La Briolle Axel , de la Pena Topete Gilberto , de Paola Angelo Amato Vicenzo , de Souza Weimar , de Veer A. , De Wolf Luc , Decoulx Eric , Deepak Sasalu , Defaye Pascal , Munoz Freddy Del-Carpio , Brkljacic Diana Delic , Deumite N. Joseph , Di Legge Silvia , Diemberger Igor , Dietz Denise , Dionísio Pedro , Dong Qiang , dos Santos Fabio Rossi , Dotcheva Elena , Doukky Rami , D’Souza Anthony , Dubrey Simon , Ducrocq Xavier , Dupljakov Dmitry , Duque Mauricio , Dutta Dipankar , Duvilla Nathalie , Eaton A. Duygun, Rainer Dziewas Charles B , Eaves William , Ebels-Tuinbeek L. A. , Ehrlich Clifford , Eichinger-Hasenauer Sabine , Eisenberg Steven J. , Jabali Adnan El , Shahawy Mahfouz El , Hernandes Mauro Esteves , Izal Ana Etxeberria , Evonich Rudolph , Evseeva Oksana , Ezhov Andrey , Fahmy Raed , Fang Quan , Farsad Ramin , Fauchier Laurent , Favale Stefano , Fayard Maxime , Fedele Jose Luis , Fedele Francesco , Fedorishina Olga , Fera Steven R. , Ferreira Luis Gustavo Gomes , Ferreira Jorge , Ferri Claudio , Ferrier Anna , Ferro Hugo , Finsen Alexandra , First Brian , Fischer Stuart , Fonseca Catarina , Almeida Luísa Fonseca , Forman Steven , Frandsen Brad , French William , Friedman Keith , Friese Athena , Fruntelata Ana Gabriela , Fujii Shigeru , Fumagalli Stefano , Fundamenski Marta , Furukawa Yutaka , Gabelmann Matthias , Gabra Nashwa , Gadsbøll Niels , Galinier Michel , Gammelgaard Anders , Ganeshkumar Priya , Gans Christopher , Quintana Antonio Garcia , Gartenlaub Olivier , Gaspardone Achille , Genz Conrad , Georger Frédéric , Georges Jean-Louis , Georgeson Steven , Giedrimas Evaldas , Gierba Mariusz , Ortega Ignacio Gil , Gillespie Eve , Giniger Alberto , Giudici Michael C. , Gkotsis Alexandros , Glotzer Taya V. , Gmehling Joachim , Gniot Jacek , Goethals Peter , Goldbarg Seth , Goldberg Ronald , Goldmann Britta , Golitsyn Sergey , Gómez Silvia , Mesa Juan Gomez , Gonzalez Vicente Bertomeu , Hermosillo Jesus Antonio Gonzalez , López Víctor Manuel González , Gorka Hervé , Gornick Charles , Gorog Diana , Gottipaty Venkat , Goube Pascal , Goudevenos Ioannis , Graham Brett , Greer G. Stephen , Gremmler Uwe , Grena Paul G. , Grond Martin , Gronda Edoardo , Grönefeld Gerian , Gu Xiang , Torres Torres Ivett Guadalupe , Guardigli Gabriele , Guevara Carolina , Guignier Alexandre , Gulizia Michele , Gumbley Michael , Günther Albrecht , Ha Andrew , Hahalis Georgios , Hakas Joseph , Hall Christian , Han Bing , Han Seongwook , Hargrove Joe , Hargroves David , Harris Kenneth B. , Haruna Tetsuya , Hayek Emil , Healey Jeff , Hearne Steven , Heffernan Michael , Heggelund Geir , Heijmeriks J. A. , Hemels Maarten , Hendriks I. , Henein Sam , Her Sung-Ho , Hermany Paul , Del Río Jorge Eduardo Hernández , Higashino Yorihiko , Hill Michael , Hisadome Tetsuo , Hishida Eiji , Hoffer Etienne , Hoghton Matthew , Hong Kui , Hong Suk keun , Horbach Stevie , Horiuchi Masataka , Hou Yinglong , Hsing Jeff , Huang Chi-Hung , Huckins David , Hughes kathy , Hung A. Huizinga, E. L. Hulsman Kuo-Chun , Hwang Gyo-Seung , Ikpoh Margaret , Imberti Davide , Ince Hüseyin , Indolfi Ciro , Inoue Shujiro , Irles Didier , Iseki Harukazu , Israel C. Noah , Iteld Bruce , Iyer Venkat , Jackson-Voyzey Ewart , Jaffrani Naseem , Jäger Frank , James Martin , Jang Sung-Won , Jaramillo Nicolas , Jarmukli Nabil , Jeanfreau Robert J. , Jenkins Ronald D. , Sánchez Carlos Jerjes , Jimenez Javier , Jobe Robert , Joen-Jakobsen Tomas , Jones Nicholas , Jorge Jose Carlos Moura , Jouve Bernard , Jung Byung Chun , Jung Kyung Tae , Jung Werner , Kachkovskiy Mikhail , Kafkala Krystallenia , Kalinina Larisa , Kallmünzer Bernd , Kamali Farzan , Kamo Takehiro , Kampus Priit , Kashou Hisham , Kastrup Andreas , Katsivas Apostolos , Kaufman Elizabeth , Kawai Kazuya , Kawajiri Kenji , Kazmierski John F. , Keeling P. , Saraiva José Francisco Kerr , Ketova Galina , Khaira AJIT Singh , Khripun Aleksey , Kim Doo-Il , Kim Young Hoon , Kim Nam Ho , Kim Dae Kyeong , Kim Jeong Su , Kim June Soo , Kim Ki Seok , Kim Jin bae , Kinova Elena , Klein Alexander , Kmetzo James J. , Kneller G. Larsen , Knezevic Aleksandar , Koh Su Mei Angela , Koide Shunichi , Kollias Anastasios , Kooistra J. A. , Koons Jay , Koschutnik Martin , Kostis William J. , Kovacic Dragan , Kowalczyk Jacek , Koziolova Natalya , Kraft Peter , Kragten Johannes A. , Krantz Mori , Krause Lars , Krenning B. J. , Krikke F. , Kromhout Z. , Krysiak Waldemar , Kumar Priya , Kümler Thomas , Kuniss Malte , Kuo Jen-Yuan , Küppers Achim , Kurrelmeyer Karla , Kwak Choong Hwan , Laboulle Bénédicte , Labovitz Arthur , Ter Lai Wen , Lam Andy , Lam Yat Yin , Zanetti Fernando Lanas , Landau Charles , Landini Giancarlo , Figueiredo Estêvão Lanna , Larsen Torben , Lavandier Karine , LeBlanc Jessica , Lee Moon Hyoung , Lee Chang-Hoon , Lehman John , Leitão Ana , Lellouche Nicolas , Lelonek Malgorzata , Lenarczyk Radoslaw , Lenderink T. , González Salvador León , Leong-Sit Peter , Leschke Matthias , Ley Nicolas , Li Zhanquan , Li Xiaodong , Li Weihua , Li Xiaoming , Lichy Christhoh , Lieber Ira , Rodriguez Ramon Horacio Limon , Lin Hailong , Lip Gregory Y. H. , Liu Feng , Liu Hengliang , Esperon Guillermo Llamas , Navarro Nassip Llerena , Lo Eric , Lokshyn Sergiy , López Amador , López-Sendón José Luís , Filho Adalberto Menezes Lorga , Lorraine Richard S. , Luengas Carlos Alberto , Luke Robert , Luo Ming , Lupovitch Steven , Lyrer Philippe , Ma Changsheng , Ma Genshan , Madariaga Irene , Maeno Koji , Magnin Dominique , Maid Gustavo , Mainigi Sumeet K. , Makaritsis Konstantinos , Malhotra Rohit , Manning Rickey , Manolis Athanasios , Hurtado Helard Andres Manrique , Mantas Ioannis , Jattin Fernando Manzur , Maqueda Vicky , Marchionni Niccolo , Ortuno Francisco Marin , Santana Antonio Martín , Martinez Jorge , Maskova Petra , Hernandez Norberto Matadamas , Matsuda Katsuhiro , Maurer Tillmann , Mauro Ciro , May Erik , Mayer Nolan , McClure John , McCormack Terry , McGarity William , McIntyre Hugh , McLaurin Brent , Palomino Feliz Alvaro Medina , Melandri Francesco , Meno Hiroshi , Menzies Dhananjai , Mercader Marco , Meyer Christian , Meyer Beat J. , Miarka Jacek , Mibach Frank , Michalski Dominik , Michel Patrik , Chreih Rami Mihail , Mikdadi Ghiath , Mikus Milan , Milicic Davor , Militaru Constantin , Minaie Sedi , Minescu Bogdan , Mintale Iveta , Mirault Tristan , Mirro Michael J. , Mistry Dinesh , Miu Nicoleta Violeta , Miyamoto Naomasa , Moccetti Tiziano , Mohammed Akber , Nor Azlisham Mohd , Mollerus Michael , Molon Giulio , Mondillo Sergio , Moniz Patrícia , Mont Lluis , Montagud Vicente , Montaña Oscar , Monti Cristina , Moretti Luciano , Mori Kiyoo , Moriarty Andrew , Morka Jacek , Moschini Luigi , Moschos Nikitas , Mügge Andreas , Mulhearn Thomas J. , Muresan Carmen , Muriago Michela , Musial Wlodzimierz , Musser Carl W. , Musumeci Francesco , Nageh Thuraia , Nakagawa Hidemitsu , Nakamura Yuichiro , Nakayama Toru , Nam Gi-Byoung , Nanna Michele , Natarajan Indira , Nayak Hemal M. , Naydenov Stefan , Nazlić Jurica , Nechita Alexandru Cristian , Nechvatal Libor , Negron Sandra Adela , Neiman James , Neuenschwander Fernando Carvalho , Neves David , Neykova Anna , Miguel Ricardo Nicolás , Nijmeh George , Nizov Alexey , Campos Rodrigo Noronha , Nossan Janko , Novikova Tatiana , Nowalany-Kozielska Ewa , Nsah Emmanuel , Fragoso Juan Carlos Nunez , Nurgalieva Svetlana , Nuyens Dieter , Nyvad Ole , de Los Rios Ibarra Manuel Odin , O’Donnell Philip , O’Donnell Martin , Oh Seil , Oh Yong Seog , Oh Dongjin , O’Hara Gilles , Oikonomou Kostas , Olivares Claudia , Oliver Richard , Ruiz Rafael Olvera , Olympios Christoforos , omaszuk-Kazberuk Anna , Asensi Joaquín Osca , jose eena Padayattil , Padilla Padilla Francisco Gerardo , Rios Victoria Padilla , Pajes Giuseppe , Pandey A. Shekhar , Paparella Gaetano , Paris F. , Park Hyung Wook , Park Jong Sung , Parthenakis Fragkiskos , Passamonti Enrico , Patel Rajesh J. , Patel Jaydutt , Patel Mehool , Patrick Janice , Jimenez Ricardo Pavón , Paz Analía , Pengo Vittorio , Pentz William , Pérez Beatriz , Ríos Alma Minerva Pérez , Pérez-Cabezas Alejandro , Perlman Richard , Persic Viktor , Perticone Francesco , Peters Terri K. , Petkar Sanjiv , Pezo Luis Felipe , Pflücke Christian , Pham David N. , Phillips Roland T. , Phlaum Stephen , Pieters Denis , Pineau Julien , Pinter Arnold , Pinto Fausto , Pisters R. , Pivac Nediljko , Pocanic Darko , Podoleanu Cristian , Politano Alessandro , Poljakovic Zdravka , Pollock Stewart , Garcéa Jose Polo , Poppert Holger , Porcu Maurizio , Reino Antonio Pose , Prasad Neeraj , Précoma Dalton Bertolim , Prelle Alessandro , Prodafikas John , Protasov Konstantin , Pye Maurice , Qiu Zhaohui , Quedillac Jean-Michel , Raev Dimitar , Grado Carlos Antonio Raffo , Rahimi Sidiqullah , Raisaro Arturo , Rama Bhola , Ramos Ricardo , Ranieri Maria , Raposo Nuno , Rashba Eric , Rauch-Kroehnert Ursula , Reddy Ramakota , Renda Giulia , Reza Shabbir , Ria Luigi , Richter Dimitrios , Rickli Hans , Rieker Werner , Vera Tomas Ripolil , Ritt Luiz Eduardo , Roberts Douglas , Briones Ignacio Rodriguez , Escudero Aldo Edwin Rodriguez , Pascual Carlos Rodríguez , Roman Mark , Romeo Francesco , Ronner E. , Roux Jean-Francois , Rozkova Nadezda , Rubacek Miroslav , Rubalcava Frank , Russo Andrea M. , Rutgers Matthieu Pierre , Rybak Karin , Said Samir , Sakamoto Tamotsu , Salacata Abraham , Salem Adrien , Bodes Rafael Salguero , Saltzman Marco A. , Salvioni Alessandro , Vallejo Gregorio Sanchez , Fernández Marcelo Sanmartín , Saporito Wladmir Faustino , Sarikonda Kesari , Sasaoka Taishi , Sati Hamdi , Savelieva Irina , Scala Pierre-Jean , Schellinger Peter , Scherr Carlos , Schmitz Lisa , Schmitz Karl-Heinz , Schmitz Bettina , Schnabel Teresa , Schnupp Steffen , Schoeniger Peter , Schön Norbert , Schwimmbeck Peter , Seamark Clare , Searles Greg , Seidl Karl-Heinz , Seidman Barry , Sek Jaroslaw , Sekaran Lakshmanan , Serrati Carlo , Shah Neerav , Shah Vinay , Shah Anil , Shah Shujahat , Sharma Vijay Kumar , Shaw Louise , Sheikh Khalid H. , Shimizu Naruhito , Shimomura Hideki , Shin Dong-Gu , Shin Eun-Seok , Shite Junya , Sibilio Gerolamo , Silver Frank , Sime Iveta , Simmers Tim A. , Singh Narendra , Siostrzonek Peter , Smadja Didier , Smith David W. , Snitman Marcelo , Filho Dario Sobral , Soda Hassan , Sofley Carl , Sokal Adam , Yan Yannie Soo Oi , Sotolongo Rodolfo , de Souza Olga Ferreira , Sparby Jon Arne , Spinar Jindrich , Sprigings David , Spyropoulos Alex C. , Stakos Dimitrios , Steinwender Clemens , Stergiou Georgios , Stiell Ian , Stoddard Marcus , Stoikov Anastas , Streb Witold , Styliadis Ioannis , Su Guohai , Su Xi , Sudnik Wanda , Sukles Kai , Sun Xiaofei , Swart H. , Szavits-Nossan Janko , Taggeselle Jens , Takagi Yuichiro , Takhar Amrit Pal Singh , Tamm Angelika , Tanaka Katsumi , Tanawuttiwat Tanyanan , Tang Sherman , Tang Aylmer , Tarsi Giovanni , Tassinari Tiziana , Tayal Ashis , Tayebjee Muzahir , Berg J. M. ten , Tesloianu Dan , The Salem H. K. , Thomas Dierk , Timsit Serge , Tobaru Tetsuya , Tomasik. Andrzej R. , Torosoff Mikhail , Touze Emmanuel , Trendafilova Elina , Tsai W. Kevin , Tse Hung Fat , Tsutsui Hiroshi , Tu Tian Ming , Tuininga Ype , Turakhia Minang , Turk Samir , Turner Wayne , Tveit Arnljot , Tytus Richard , Valadão C. , van Bergen P. F. M. M. , van de Borne Philippe , van den Berg B. J. , van der Zwaan C. , Van Eck M. , Vanacker Peter , Vasilev Dimo , Vasilikos Vasileios , Vasilyev Maxim , Veerareddy Srikar , Miño Mario Vega , Venkataraman Asok , Verdecchia Paolo , Versaci Francesco , Vester Ernst Günter , Vial Hubert , Victory Jason , Villamil Alejandro , Vincent Marc , Vlastaris Anthony , Dahl Jürgen vom , Vora Kishor , Vranian Robert B. , Wakefield Paul , Wang Ningfu , Wang Mingsheng , Wang Xinhua , Wang Feng , Wang Tian , Warner Alberta L. , Watanabe Kouki , Wei Jeanne , Weimar Christian , Weiner Stanislav , Weinrich Renate , Wen Ming-Shien , Wiemer Marcus , Wiggers Preben , Wilke Andreas , Williams David , Williams Marcus L. , Witzenbichler Bernhard , Wong Brian , Wong Ka Sing Lawrence , Wozakowska-Kaplon Beata , Wu Shulin , Wu Richard C. , Wunderlich Silke , Wyatt Nell , Wylie John , Xu Yong , Xu Xiangdong , Yamanoue Hiroki , Yamashita Takeshi , Yan Ping Yen Bryan , Yang Tianlun , Yao Jing , Yeh Kuo-Ho , Yin Wei Hsian , Yotov Yoto , Zahn Ralf , Zarich Stuart , Zenin Sergei , Zeuthen Elisabeth Louise , Zhang Huanyi , Zhang Donghui , Zhang Xingwei , Zhang Ping , Zhang Jun , Zhao Shui Ping , Zhao Yujie , Zhao Zhichen , Zheng Yang , Zhou Jing , Zimmermann Sergio , Zini Andrea , Zizzo Steven , Zong Wenxia , Steven Zukerman L. 
Published: August 2023

The 2MACE score was specifically developed as a risk-stratification tool in atrial fibrillation (AF) to predict cardiovascular outcomes. We evaluated the predictive ability of the 2MACE score in the GLORIA-AF registry. All eligible patients from phase II/III of the prospective global GLORIA-AF registry were included. Major adverse cardiac events (MACEs) were defined as the composite outcome of stroke, myocardial infarction and cardiovascular death. Cox proportional hazards were used to examine the relationship between the 2MACE score and study outcomes. Predictive capability of the 2MACE score was investigated using receiver-operating characteristic curves. A total of 25,696 patients were included (mean age 71 years, female 44.9%). Over 3 years, 1583 MACEs were recorded. Patients who had MACE were older, with more cardiovascular risk factors and were less likely to be managed using a rhythm-control strategy. The median 2MACE score in the MACE and non-MACE groups were 2 (IQR 1–3) and 1 (IQR 0–2), respectively (p < 0.001). The 2MACE score was positively associated with an increase in the risk of MACE, with a score of ≥ 2 providing the best combination of sensitivity (69.6%) and specificity (51.6%), HR 2.47 (95% CI, 2.21–2.77). The 2MACE score had modest predictive performance for MACE in patients with AF (AUC 0.655 (95% CI, 0.641–0.669)). Our analysis in this prospective global registry demonstrates that the 2MACE score can adequately predict the risk of MACE (defined as myocardial infarction, CV death and stroke) in patients with AF. Clinical trial registration:http://www.clinicaltrials.gov. Unique
identifiers: NCT01468701, NCT01671007 and NCT01937377