Usefulness of The CHADS2 and CHA2DS2-VASc Scores in Predicting In-Hospital Mortality in Acute Coronary Syndrome Patients: A Single-Center Retrospective Cohort Study
CHA2DS2-VASc and ACS
Abstract
Background
Although the GRACE risk score is widely accepted as an established scoring system to predict in-hospital mortality in acute coronary syndrome (ACS) patients, this scoring system still depends on electrocardiography and laboratory findings to determine the results. Therefore, we aim to retrospectively evaluate the association between the CHADS2 and CHA2DS2-VASc score as an anamnesis-only mediated scoring system and in-hospital mortality in hospitalized ACS patients.
Methods
This retrospective cohort study analyzed data of ACS patients from the ACS registry in Dr. Hasan Sadikin Central General Hospital from 2018 to 2021. The outcome of this study was in-hospital mortality. The association between these scoring system and in-hospital mortality were evaluated using binary logistic regression analysis. Receiver operating characteristics (ROC) analysis was also performed to assess the success rate of this scoring system in predicting in-hospital mortality.
Results
A total of 1339 patients were included in this study, and 162 (12.1%) of them died in the hospital. High CHA2DS2-VASc score group (cut-off >2) was significantly associated with higher risk of in-hospital mortality before (OR=2.56 [1.75,3.75]; p<0.001) and after adjustment of several confounding factors (OR=3.39 [1.73,6.64]; p<0.001). Meanwhile, the high CHADS2 score (cutoff >2) was only significantly increased the risk of in-hospital mortality in univariate analysis (OR=2.05[1.47,2.87];p<0.001), but was not significantly associated with in-hospital mortality after multivariate analysis (OR=1.31 [0.92,1.86];p=0.129). ROC analysis revealed that predictive accuracy of CHA2DS2-VASc score was significantly greater compared to CHADS2 score (AUC: 0.653 vs 0.609, p<0.001). However, the predictive value of CHA2DS2-VASc score was significantly lower than the GRACE risk score (AUC: 0.789 vs 0.653, p<0.001).
Conclusion
Our study showed that the CHA2DS2-VASc score >2 was significantly and independently associated with higher in-hospital mortality in ACS patients compared to the CHA2DS2-VASc score of 1 or lower. Despite its lower predictive accuracy compared to the GRACE risk score, CHA2DS2-VASc score can still be used in practical situations as an alternative scoring system in predicting in-hospital mortality in ACS patients, especially in primary health care settings located in rural areas that lack the diagnostic facilities.
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References
2. Aguado-Romeo MJ, Márquez-Calderón S, Buzón-Barrera ML. Hospital mortality in acute coronary syndrome: differences related to gender and use of percutaneous coronary procedures. BMC Health Serv Res. 2007 Jul 13;7:110.
3. Shuvy M, Beeri G, Klein E, Cohen T, Shlomo N, Minha S, et al. Accuracy of the Global Registry of Acute Coronary Events (GRACE) Risk Score in Contemporary Treatment of Patients With Acute Coronary Syndrome. Can J Cardiol. 2018 Dec;34(12):1613–7.
4. Lip GYH, Nieuwlaat R, Pisters R, Lane DA, Crijns HJGM. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest. 2010 Feb;137(2):263–72.
5. Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA. 2001 Jun 13;285(22):2864–70.
6. Peng H, Sun Z, Chen H, Zhang Y, Ding X, Zhao X-Q, et al. Usefulness of the CHA2DS2-VASc Score to Predict Adverse Outcomes in Acute Coronary Syndrome Patients Without Atrial Fibrillation Undergoing Percutaneous Coronary Intervention. Am J Cardiol. 2019 Aug 15;124(4):476–84.
7. Ma X, Shao Q, Dong L, Cheng Y, Lv S, Shen H, et al. Prognostic value of CHADS2 and CHA2DS2-VASc scores for post-discharge outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Medicine. 2020 Jul 24;99(30):e21321.
8. Scudiero F, Zocchi C, De Vito E, Tarantini G, Marcucci R, Valenti R, et al. Relationship between CHA2DS2-VASc score, coronary artery disease severity, residual platelet reactivity and long-term clinical outcomes in patients with acute coronary syndrome. Int J Cardiol. 2018 Jul 1;262:9–13.
9. Huang S-S, Chen Y-H, Chan W-L, Huang P-H, Chen J-W, Lin S-J. Usefulness of the CHADS2 score for prognostic stratification of patients with acute myocardial infarction. Am J Cardiol. 2014 Nov 1;114(9):1309–14.
10. Rozenbaum Z, Elis A, Shuvy M, Vorobeichik D, Shlomo N, Shlezinger M, et al. CHA2DS2-VASc score and clinical outcomes of patients with acute coronary syndrome. Eur J Intern Med. 2016 Dec;36:57–61.
11. Chua S-K, Lo H-M, Chiu C-Z, Shyu K-G. Use of CHADS₂ and CHA₂DS₂-VASc scores to predict subsequent myocardial infarction, stroke, and death in patients with acute coronary syndrome: data from Taiwan acute coronary syndrome full spectrum registry. PLoS One. 2014;9(10):e111167.
12. Podolecki T, Lenarczyk R, Kowalczyk J, Swierad M, Swiatkowski A, Jedrzejczyk E, et al. Stroke and death prediction with CHA2DS2-vasc score after myocardial infarction in patients without atrial fibrillation. J Cardiovasc Med (Hagerstown). 2015 Jul;16(7):497–502.
13. Poçi D, Hartford M, Karlsson T, Herlitz J, Edvardsson N, Caidahl K. Role of the CHADS2 score in acute coronary syndromes: risk of subsequent death or stroke in patients with and without atrial fibrillation. Chest. 2012 Jun;141(6):1431–40.
14. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). European Heart Journal. 2018 Jan 7;39(2):119–77.
15. Collet J-P, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). European Heart Journal. 2021 Apr 7;42(14):1289–367.
16. Lip GYH, Frison L, Halperin JL, Lane DA. Identifying patients at high risk for stroke despite anticoagulation: a comparison of contemporary stroke risk stratification schemes in an anticoagulated atrial fibrillation cohort. Stroke. 2010 Dec;41(12):2731–8.
17. Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. European Heart Journal. 2021 Feb 1;42(5):373–498.
18. Rivera‐Caravaca JM, Roldán V, Esteve‐Pastor MA, Valdés M, Vicente V, Lip GYH, et al. Long‐Term Stroke Risk Prediction in Patients With Atrial Fibrillation: Comparison of the ABC‐Stroke and CHA 2 DS 2‐VASc Scores. J Am Heart Assoc. 2017 Jul 20;6(7):e006490.
19. Johansson S, Rosengren A, Young K, Jennings E. Mortality and morbidity trends after the first year in survivors of acute myocardial infarction: a systematic review. BMC Cardiovascular Disorders. 2017 Feb 7;17(1):53.
20. Kaul P, Ezekowitz JA, Armstrong PW, Leung BK, Savu A, Welsh RC, et al. Incidence of heart failure and mortality after acute coronary syndromes. Am Heart J. 2013 Mar;165(3):379-385.e2.
21. Hochman JS, Tamis JE, Thompson TD, Weaver WD, White HD, Van de Werf F, et al. Sex, clinical presentation, and outcome in patients with acute coronary syndromes. Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes IIb Investigators. N Engl J Med. 1999 Jul 22;341(4):226–32.
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