Predictive value of CHADS2 score for cardiovascular events in patients with acute coronary syndrome and documented coronary artery disease

The CHA2DS2-VASC Score Predicts Mortality in Patients Undergoing Coronary Angiography

BACKGROUND

The CHA2DS2-VASC score is used to predict the risk of thromboembolic complications in patients with atrial fibrillation (AF). We hypothesized that the CHA2DS2-VASC score can be used to predict mortality in patients undergoing coronary angiography.

METHODS AND RESULTS

This was a prospective study of 990 patients undergoing coronary angiography. The median follow-up was 2294 days. The patients were categorized into two groups according to their CHA2DS2-VASC score: group I had scores <4 and group II had scores ≥4 (527 (53.2%) and 463 (46.8%), respectively). A Kaplan-Meier analysis demonstrated a significant association between the CHA2DS2-VASC score and mortality (69/527 (13.1%) vs. 179/463 (38.7%) for group I vs. group II, respectively, p < 0.0001). The association remained significant in patients with and without AF, reduced and preserved LVEF, normal and reduced kidney function, and with and without ACS (p < 0.009 to p < 0.0001 for all). In the Cox regression model, which combined the CHA2DS2-VASC score, the presence of AF, LVEF, anemia, and renal insufficiency, an elevated CHA2DS2-VASC score of ≥4 was independently associated with higher mortality (HR 2.12, CI 1.29-3.25, p = 0.001).

CONCLUSIONS

The CHA2DS2VASC score is a simple and reliable mortality predictor in patients undergoing coronary angiography and should be used for the initial screening for such patients.

Validation and Comparison of Six Risk Scores for Infection in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Aims: Very few of the risk scores to predict infection in ST-segment elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI) have been validated, and reports on their differences. We aimed to validate and compare the discriminatory value of different risk scores for infection.

Methods: A total of 2,260 eligible patients with STEMI undergoing PCI from January 2010 to May 2018 were enrolled. Six risk scores were investigated: age, serum creatinine, or glomerular filtration rate, and ejection fraction (ACEF or AGEF) score; Canada Acute Coronary Syndrome (CACS) risk score; CHADS₂ score; Global Registry for Acute Coronary Events (GRACE) score; and Mehran score conceived for contrast induced nephropathy. The primary endpoint was infection during hospitalization.

Results: Except CHADS₂ score (AUC, 0.682; 95%CI, 0.652–0.712), the other risk scores showed good discrimination for predicting infection. All risk scores but CACS risk score (calibration slope, 0.77; 95%CI, 0.18–1.35) showed best calibration for infection. The risks scores also showed good discrimination for in-hospital major adverse clinical events (MACE) (AUC range, 0.700–0.786), except for CHADS₂ score. All six risk scores showed best calibration for in-hospital MACE. Subgroup analysis demonstrated similar results.

Conclusions: The ACEF, AGEF, CACS, GRACE, and Mehran scores showed a good discrimination and calibration for predicting infection and MACE.

Utilization of NaF-PET/CT in assessing global cardiovascular calcification using CHADS2 and CHADS2-VASc scoring systems in high risk individuals for cardiovascular disease

CHADS₂ and CHA₂DS₂-VASc scores are used to estimate the risk of strokes in patients with atrial fibrillation. We sought to determine the global quantification of cardiovascular molecular calcification in high risk individuals by NaF-PET/CT and compare it with CHADS₂ and CHA₂DS₂-VASc scores. We identified 40 high risk individuals for cardiovascular disease from the Cardiovascular Molecular Calcification Assessed by ¹⁸F-NaF PET CT (CAMONA) trial and calculated CHADS₂ and CHADS₂-VASc scores for each. Ninety minutes after NaF injection (2.2 Mbq/kg), PET/CT imaging was performed. CT imaging was done for attenuation correction and anatomic correlation. The global cardiac uptake was calculated from regions of interest manually drawn on axial PET/CT images made in OsirixMD. Global cardiac average SUVmean (aSUVmean) values were calculated, and linear regression analysis was employed for statistical purposes. Subjects had mean age of 55 ± 11.9 SD years, (Range: 23-73 years), female 55%. The sample consisted of subjects with a mean aSUVmax of 2.9 ± 1.4, aSUVmean was 0.8 ± 0.2, CHADS₂ 0.9 ± 0.6 (Range: 0-3), CHA₂DS₂-VASc 1.8 ± 1.3 (Range: 0-5). Based on the linear regression models, we found a direct correlation between global cardiac aSUVmean and CHADS₂ score (r=0.58, P≤0.0001) and also between global cardiac aSUVmean and CHA₂DS₂-VASc (r=0.37, P=0.01). Based on the results of our study we conclude that patients with a higher CHADS₂ and CHA₂DS₂-VASc scores had a higher atherosclerotic burden and could be at greater risk of cardiovascular events. These scoring systems can help with risk stratification for predicting future adverse atherosclerotic events.

Prognostic Value of the CHADS2 Score for Adverse Cardiovascular Events in Coronary Artery Disease Patients Without Atrial Fibrillation-A Multi-Center Observational Cohort Study

Background

The CHADS₂ score has mainly been used to predict the likelihood of cerebrovascular accidents in patients with atrial fibrillation. However, increasing attention is being paid to this scoring system for risk stratification of patients with coronary artery disease. We investigated the value of the CHADS₂ score in predicting cardiovascular/cerebrovascular events in coronary artery disease patients without atrial fibrillation.

Methods and Results

This was a multicenter, observational cohort study. The subjects had been admitted to one of the participating institutions with coronary artery disease requiring percutaneous coronary intervention. We calculated the CHADS₂ scores for 7082 patients (mean age, 69.7 years; males, 71.9%) without clinical evidence of atrial fibrillation. Subjects were subdivided into low‐ (0–1), intermediate‐ (2–3), and high‐score (4–6) groups and followed for 1 year. The end point was a composite of cardiovascular/cerebrovascular death, nonfatal myocardial infarction, and ischemic stroke at 1‐year follow‐up. Rates of triple‐vessel/left main trunk disease correlated positively with CHADS₂ score categories. CHADS₂ scores among single, double, and triple‐vessel/left main trunk groups were 2 (1–2), 2 (1–3), and 2 (2–3), respectively (P<0.001). A total of 194 patients (2.8%) had a cardiovascular/cerebrovascular event, and Kaplan–Meier analysis demonstrated a significantly higher probability of cardiovascular/cerebrovascular events in proportion to a higher CHADS₂ score (log‐rank test, P<0.001). Multivariate Cox hazard analysis identified CHADS₂ score (per 1 point) as an independent predictor of cardiovascular/cerebrovascular events (hazard ratio, 1.31; 95% CI, 1.17–1.47; P<0.001).

Conclusions

This large cohort study indicated that the CHADS₂ score is useful for the prediction of cardiovascular/cerebrovascular events in coronary artery disease patients without atrial fibrillation.

Predictive value of CHADS2 and CHA2DS2-VASc scores for acute myocardial infarction in patients with atrial fibrillation

The presence of acute myocardial infarction (AMI) confers a poor prognosis in atrial fibrillation (AF), associated with increased mortality dramatically. This study aimed to evaluate the predictive value of CHADS₂ and CHA₂DS₂-VASc scores for AMI in patients with AF. This retrospective study enrolled 5140 consecutive nonvalvular AF patients, 300 patients with AMI and 4840 patients without AMI. We identified the optimal cut-off values of the CHADS₂ and CHA₂DS₂-VASc scores each based on receiver operating characteristic curves to predict the risk of AMI. Both CHADS₂ score and CHA₂DS₂-VASc score were associated with an increased odds ratio of the prevalence of AMI in patients with AF, after adjustment for hyperlipidaemia, hyperuricemia, hyperthyroidism, hypothyroidism and obstructive sleep apnea. The present results showed that the area under the curve (AUC) for CHADS₂ score was 0.787 with a similar accuracy of the CHA₂DS₂-VASc score (AUC 0.750) in predicting “high-risk” AF patients who developed AMI. However, the predictive accuracy of the two clinical-based risk scores was fair. The CHA₂DS₂-VASc score has fair predictive value for identifying high-risk patients with AF and is not significantly superior to CHADS₂ in predicting patients who develop AMI.

CHADS2, CHA2DS2-VASc and R2CHADS2 scores predict mortality in patients with coronary artery disease

Few studies to date address the predictive ability of CHA₂DS₂-VASc and R₂CHADS₂ in CAD patients. Our aim is to investigate the prognostic performance of CHADS₂, CHA₂DS₂-VASc and R₂CHADS₂ scores in patients with coronary artery disease (CAD). Angiographically obstructive CAD patients were enrolled. The prognostic performance of the three risk scores was evaluated using Cox hazards models. In addition, we compared their predictive values by calculating C statistics, net reclassification improvement (NRI) and integrated discrimination improvement (IDI). The endpoints are death from any cause and cardiovascular death. Of 3295 subjects with CAD, the mean CHADS₂, CHA₂DS₂-VASc and R₂CHADS₂ scores are 1.2 ± 1.0, 2.4 ± 1.4, and 1.6 ± 1.4, respectively. The CHADS₂-guided risk classification is markedly distinct from CHA₂DS-₂-VASc- and R₂CHADS₂-guided ones. Over a median follow-up of 24 months, a total of 290 (rate 4.00/100 person-year) deaths occurred, and 163 (rate 2.2/100 person-year) were attributed to cardiovascular deaths. Event rates increase by CHADS₂, CHA₂DS₂-VASc and R₂CHADS₂ (P for trend <0.001). The multivariate analyses show 60, 111 and 82% higher risk of mortality per unit increase of CHADS₂, CHA₂DS₂-VASc and R₂CHADS₂ scores, respectively. Comparing with CHADS₂ score (c-statistic = 0.61), CHA₂DS₂-VASc (c-statistic 0.65, NRI 0.52 and IDI 0.06, P for all <0.05) and R₂CHADS₂ (c-statistic 0.66, NRI 0.43 and IDI 0.09, P for all <0.05) scores provide better discrimination and reclassification for mortality. Also, CHA₂DS₂-VASc and R₂CHADS₂ have comparable predictive ability of mortality to the GRACE score. The CHADS₂, CHA₂DS₂-VASc and R₂CHADS₂ scores are simple yet robust prognostic tools in CAD patients.