CHA2DS2-VASc score for in-hospital recurrence risk stratification in patients with myocardial infarction

Abstract

BackgroundUsing the CHA2DS2-VASc score to recognize the risk of stroke in patients with atrial fibrillation has been well-established. However, few studies have assessed whether the CHA2DS2-VASc score has a similar predictive value in recurrence after myocardial infarction (MI).MethodsWe conducted a retrospective observational cohort study of adult inpatients with MI. The CHA2DS2-VASc and modified CHA2DS2-VASc (MCHA2DS2-VASc) scores of all patients were calculated. The associations of both scores with recurrent MI were analyzed.ResultsA total of 6,700 patients with MI (60.0 ± 11.1 years, 77.2% men) were enrolled, and 759 (11.3%) presented a definite recurrence during hospitalization. After multivariable adjustment by logistic regression in patients with MI, the CHA2DS2-VASc and MCHA2DS2-VASc scores were independently associated with recurrence. The MCHA2DS2-VASc score showed a better predictive value for risk of recurrence than that of CHA2DS2-VASc in overall [area under the receiver operating characteristic curve (AUC) 0.757 vs. 0.676] or male patients (AUC 0.759 vs. 0.708). MCHA2DS2-VASc was superior to CHA2DS2-VASc for identifying “truly high-risk” patients with MI, regardless of overall patients or sex-specific subgroups. The two scores had a similar focus on the identification of “low-risk” patients in overall or women, but not in men.ConclusionThe CHA2DS2-VASc and MCHA2DS2-VASc scores for predicting recurrence are validated in patients with MI. However, MCHA2DS2-VASc could be more helpful to secondary prevention than CHA2DS2-VASc after MI, especially in men. The superiority of MCHA2DS2-VASc compared with CHA2DS2-VASc in women is just more discriminatory for “truly high-risk” patients.

Role of Malnutrition in Atrial Fibrillation: A Prospective Study including Individuals ≥ 75 Years of Age

“…The CHA 2 DS 2 -VASc score is the most commonly used scoring system for initiating anticoagulant therapy. According to this scoring, it is recommended that anticoagulant therapy be initiated in all patients with AF over 75 years of age to prevent cerebrovascular thromboembolism [37]. In particular, it is aimed to elucidate the risk factors of AF, which can cause fatal complications in patients over 75 years of age, and to improve the quality of life and longevity of the elderly.…”