Novel CHA2DS2-VASc-HSF is Superior to CHADS2 and CHA2DS2-VASc Score to Predict the Risk of Severe Coronary Artery Disease

Abstract

BACKGROUND: Various risk scoring methods are available to predict the severity of coronary artery disease (CAD). However, the majority of them are complex and require advanced technologies, thus limiting its usage in primary care settings. CHA2DS2-VASc-HSF is a novel risk scoring which we develop from CHA2DS2-VASc score.
 AIM: We hypothesize that CHA2DS2-VASc-HSF is predictive for the risk of severe CAD, and we compare its validity with previously established CHADS2 and CHA2DS2-VASc score.
 MATERIALS AND METHODS: A total of 210 patients who underwent elective coronary angiography were enrolled in our study. Anthropometric, laboratory, angiographic findings, and patient history were obtained from medical records and used to calculate CHA2DS2-VASc-HSF score. Severe CAD defined as coronary artery occlusion with the Gensini score of ≥20. Statistical analyses were done using SPSS 25.0 and MedCalc 18.2.1.
 RESULTS: This research showed that the patient with severe CAD has significantly higher CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-HSF score compared to normal and mild CAD (p < 0.001). CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-HSF correlated significantly with the CAD severity (r = 0.315, p ≤ 0.001; r = 0.395, p ≤ 0.001; r = 0.612, p ≤ 0.001, respectively). CHA2DS2-VASc-HSF may predict the risk of severe CAD independent from other variables (odds ratio = 2.540; 95% confidence interval = 1.794–3.595; p = 0.002) with the cutoff value of ≥2.5 (sensitivity = 81.4% and specificity = 68.1%). Pairwise comparison of receiver operating characteristic curves showed that CHA2DS2-VASc-HSF was superior to predict severe CAD.
 CONCLUSIONS: CHA2DS2-VASc-HSF scores may predict the risk of severe CAD better than CHADS2 and CHA2DS2-VASc score. This score may easily be used in primary care physicians to predict the risk of severe CAD and provide an early referral to the cardiologist.

Coronary artery disease severity and risk stratification of patients with non ST-elevation acute coronary syndrome using CHA2DS2-VASc-HSF score

“…Moreover, they found that CHA 2 DS 2 -VASc-HS score was the best scoring system to predict CAD severity in stable CAD patients. Other studies reported the same findings in stable CAD which enrolled a large number of studied patients and included the family history of CAD to the score to be CHA 2 DS 2 -VASc -HSF [ 17 , 18 ]. However, our study focused on NSTE ACS patients who are a high-risk group of patients.…”

“…Besides, the current study added the family history of CAD to the score which is shared by 27% as a risk factor that increases the likelihood prediction of CAD severity. The previous studies [ 9 , 17 , 18 ] used the number of diseased coronary arteries and the Gensini score to assess the CAD severity which depends on the presence of > 50% stenosis in a coronary artery which may not be indicative of the clinical importance of the CAD severity. This differs from our study which used the SS which assesses the lesion characteristics including complexity such as bifurcation and osteal locations, morphology, and location on the coronary artery reflecting the severity and complexity of the CAD.…”

Atrial Fibrillation and Chronic Coronary Ischemia: A Challenging Vicious Circle

“…However, this score cannot assess the severity of coronary artery disease, unlike the CHA2DS2-VASc-HSF score (which adds one point for hyperlipidemia, smoking, and family history of heart disease). This score is found to be extremely useful for assessing the severity of CCS according to recent data supporting the significant correlation between it and the Gensini coronary artery angiographic assessment score (Table 3) [94]. Two other variants of the CHA2DS2-VASc score, namely CHA2DS2-VASc-RAF (R assigns 1 point for renal dysfunction and AF is the type of AF) and CHA2DS2-VASc-LAF (L is left atrial diameter and AF is the type of AF), have been shown to be very useful in the prediction of left atrial thrombosis and spontaneous contrast on echocardiographic examination in patients with nonvalvular AF, but further studies are needed to establish any possible link also with the presence of CCS in these patients [88].…”

“…However, this score cannot assess the severity of coronary artery disease, unlike the CHA2DS2-VASc-HSF score (which adds one point for hyperlipidemia, smoking, and family history of heart disease). This score is found to be extremely useful for assessing the severity of CCS according to recent data supporting the significant correlation between it and the Gensini coronary artery angiographic assessment score ( Table 3 ) [ 94 ].…”

CHA2DS2-VASc-HSF Score may Better Predict the Development of Total Coronary Artery Occlusion in Acute Coronary Syndrome

“…For example, Modi et al 10 found that this new score more successfully predicted the severity of CAD than the CHADS2 and CHADS2-VASc scores. Andrianto et al 11 reported the better performance of CHA2DS2-VASc-HSF score in predicting of CAD severity compared with CHADS2 and CHADS2-VASc scores. In another study, 12 the CHA2DS2-VASc-HSF score was more successful in showing no-reflow phenomenon after PCI in patients with acute coronary syndrome compared with the CHADS2 and CHA2DS2-VASc scores.…”