eISSN: 1897-4295
ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
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SCImago Journal & Country Rank
4/2018
vol. 14
 
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abstract:
Original paper

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

Michał Węgiel, Tomasz Rakowski, Artur Dziewierz, Joanna Wojtasik-Bakalarz, Danuta Sorysz, Stanisław Bartuś, Andrzej Surdacki, Dariusz Dudek

Adv Interv Cardiol 2018; 14, 4 (54): 391–398
Online publish date: 2018/12/11
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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.

keywords:

acute coronary syndrome, risk, mortality

references:
Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 2016; 37: 2893-962.
Zhu WG, Xiong QM, Hong K. Meta-analysis of CHADS2 versus CHA2DS2-VASc for predicting stroke and thromboembolism in atrial fibrillation patients independent of anticoagulation. Tex Heart Inst J 2015; 42: 6-15.
Lip GY, Frison L, Halperin JL, et al. 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; 41: 2731-8.
Piccini JP, Stevens SR, Chang Y, et al. Renal dysfunction as a predictor of stroke and systemic embolism in patients with nonvalvular atrial fibrillation: validation of the R(2)CHADS(2) index in the ROCKET AF (Rivaroxaban Once-daily, oral, direct factor Xa inhibition Compared with vitamin K antagonism for prevention of stroke and Embolism Trial in Atrial Fibrillation) and ATRIA (AnTicoagulation and Risk factors In Atrial fibrillation) study cohorts. Circulation 2013; 127: 224-32.
Kruk M, Przyłuski J, Kalińczuk L, et al. Risk is not flat. Comprehensive approach to multidimensional risk management in ST-elevation myocardial infarction treated with primary angioplasty (ANIN STEMI Registry). Postep Kardiol Interw 2013; 9: 212-20.
Sarek J, Paczkowska A, Wilczyński B, et al. Gender-related differences in long-term outcome among high-risk patients with myocardial infarction treated invasively. Postep Kardiol Interw 2017; 13: 107-16.
Rozenbaum Z, Elis A, Shuvy M, et al. CHA2DS2-VASc score and clinical outcomes of patients with acute coronary syndrome. Eur J Intern Med 2016; 36: 57-61.
Bozbay M, Uyarel H, Cicek G, et al. CHA2DS2-VASc score predicts in-hospital and long-term clinical outcomes in patients with ST-segment elevation myocardial infarction who were undergoing primary percutaneous coronary intervention. Clin Appl Thromb Hemost 2017; 23: 132-8.
Fox KA, Fitzgerald G, Puymirat E, et al. Should patients with acute coronary disease be stratified for management according to their risk? Derivation, external validation and outcomes using the updated GRACE risk score. BMJ Open 2014; 4: e004425.
Antman EM, Cohen M, Bernink PJ, et al. The TIMI risk score for unstable angina/non-ST elevation MI: a method for prognostication and therapeutic decision making. JAMA 2000; 284: 835-42.
Morrow DA, Antman EM, Charlesworth A, et al. TIMI risk score for ST-elevation myocardial infarction: a convenient, bedside, clinical score for riskassessment at presentation: an intravenous nPA for treatment of infarcting myocardium early II trial substudy. Circulation 2000; 102: 2031-7.
Addala S, Grines CL, Dixon SR, et al. Predicting mortality in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention (PAMI risk score). Am J Cardiol 2004; 93: 629-32.
Cicek G, Yıldırım E. CHA2DS2-VASc score predicts contrast induced nephropathy in patients with ST-segment elevation myocardial infarction who were undergoing primary percutaneous coronary intervention. Kardiol Pol 2018; 76: 91-8.
Ooi H, Chen LH, Ni YL, et al. CHA2DS2-VASc scores predict major adverse cardiovascular events in patients with chronic obstructive pulmonary disease. Clin Respir J 2018; 12: 1038-45.
Uysal OK, Turkoglu C, Duran M, et al. Predictive value of newly defined CHA2DS2-VASc-HSF score for severity of coronary artery disease in ST segment elevation myocardial infarction. Kardiol Pol 2016; 74: 954-60.
Kilic S, Kocabas U, Can LH, et al. Predictive value of CHA2DS2-VASc and CHA2DS2-VASc-HS scores for failed reperfusion after thrombolytic therapy in patients with ST-elevation myocardial ınfarction. Cardiol J 2018 Mar 7. doi: 10.5603/CJ.a2018.0017 [Epub ahead of print].
Wybraniec MT, Faryan M, Kusz B, et al. CHA2DS2-VASC-AF2 score accurately predicts moderate-to-severe acute neurological dysfunction in the course of first ever ischaemic stroke. Int J Cardiol 2017; 228: 286-8.
Lau KK, Chan PH, Yiu KH, et al. Roles of the CHADS2 and CHA2DS2-VASc scores in post-myocardial infarction patients: risk of new occurrence of atrial fibrillation and ischemic stroke. Cardiol J 2014; 21: 474-83.
Podolecki T, Lenarczyk R, Kowalczyk J, et al. Stroke and death prediction with CHA2DS2-vasc score after myocardial infarction in patients without atrial fibrillation. J Cardiovasc Med 2015; 16: 497-502.
Poçi D, Hartford M, Karlsson T, et al. Role of the CHADS2 score in acute coronary syndromes: risk of subsequent death or stroke in patients with and without atrial fibrillation. Chest 2012; 141: 1431-40.
Barra S, Almeida I, Caetano F, et al. Stroke prediction with an adjusted R-CHA2DS2VASc score in a cohort of patients with a myocardial infarction. Thromb Res 2013; 132: 293-9.
Kiliszek M, Szpakowicz A, Filipiak KJ, et al. CHA2DS2-VASc and R2CHA2DS2-VASc scores have predictive value in patients with acute coronary syndromes. Pol Arch Med Wewn 2015; 125: 545-52.
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