Risk is not flat. Comprehensive approach to multidimensional risk management in ST-elevation myocardial infarction treated with primary angioplasty (ANIN STEMI Registry)

CHA2DS2-VASc and R2-CHA2DS2-VASc scores predict in-hospital and post-discharge outcome in patients with myocardial infarction

Introduction

The CHA₂DS₂-VASc and R₂-CHA₂DS₂-VASc scores were initially designed to evaluate the risk of cerebrovascular events in patients with atrial fibrillation. However, these scales consist of parameters which are well known as general risk factors for cardiovascular events.

Aim

To assess the role of the CHA₂DS₂-VASc and R₂-CHA₂DS₂-VASc scores in predicting outcome of patients with myocardial infarction (MI).

Material and methods

We enrolled 212 consecutive patients with both ST-elevation and non-ST-elevation MI referred for primary percutaneous coronary intervention (PCI). Patients were divided into two groups depending on the CHA₂DS₂-VASc score: ≤ 3 (low score) and > 3 points (high score).

Results

The group with a CHA₂DS₂-VASc score > 3 points consisted of 93 (44%) patients. Follow-up was available in 200 (94.3%) patients with median duration of 10 (Q1: 6; Q3: 13) months. During the follow-up all-cause mortality was greater in patients from the high score group (21%) compared to patients with lower scores (8%) (p = 0.009). Recurrent MI was found in 4% of patients from the low score group and in 13% of patients from the high score group (p = 0.024). The combined endpoint of cardiovascular mortality, recurrent non-fatal MI and non-fatal stroke occurred in 13% of lower score patients and in 30% of patients with a score > 3 points (p = 0.002). In a Cox regression model both scores were predictors of all-cause mortality with a hazard ratio of 1.31 per 1 point increase for the CHA₂DS₂-VASc score (p = 0.004) and 1.36 for the R₂-CHA₂DS₂-VASc score (p < 0.001).

Conclusions

The CHA₂DS₂-VASc and R₂-CHA₂DS₂-VASc scores predict in-hospital and post-discharge outcome in patients with acute MI undergoing primary PCI.