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Objective To determine if the CHA2DS2-VASc score predicts thromboembolism and death in patients without atrial fibrillation in a population with implantable cardiac monitoring devices. Methods A retrospective review utilizing the Rochester Epidemiology Project research infrastructure was conducted to evaluate the CHA2DS2-VASc tool as a predictor of mortality and ischemic stroke, transient ischemic attack, or systemic embolism in patients without atrial fibrillation. An implantable device was required in the inclusion criteria to discern the absence of atrial fibrillation. The study period was January 1, 2004 through March 7, 2016. Results The population (n = 1,606) had a mean age of 69.8 years (SD 3.4 years) and median follow-up of 4.8 years (range 0 to 12 years, Q1: 2.6 years, Q3: 8.1 years). The number of thromboembolic and mortality events stratified by CHA2DS2-VASc score groupings of 0 to 2, 3 to 5, and 6 to 9 were 12 (3%), 109 (14%), and 123 (27%); and 22 (6%), 205 (27%), and 214 (47%), respectively. The CHA2DS2-VASc score predicted thromboembolism and death. The hazard ratios for thromboembolic events for CHA2DS2-VASc scores 3 to 5 and 6 to 9 were 4.84 (CI 2.66 to 8.80) and 10.53 (CI 5.77 to 19.21) (reference group: scores 0 to 2). The hazard ratios for death for the corresponding score categories were 4.45 (CI 2.86 to 6.91) and 8.18 (CI 5.23 to 12.78). The CHA2DS2-VASc score also predicted development of atrial fibrillation, where the hazard ratios for scores 3 to 5 and 6 to 9 were 1.51 (CI 1.13 to 2.00) and 2.17 (CI 1.60 to 2.95). Conclusion The CHA2DS2-VASc tool predicts thromboembolic events and overall mortality in those without atrial fibrillation in a population with implantable devices.

Paracentral acute middle maculopathy lesions have been described in eyes with retinal vascular disease and in people with systemic vascular diseases or events. This is the first described case of a PAMM lesion in the absence of associated factors other than an uncomplicated pregnancy.