Stroke prediction with an adjusted R-CHA2DS2VASc score in a cohort of patients with a Myocardial Infarction

Barra, Sérgio; Almeida, Inês; Caetano, Francisca; Providência, Rui; Paiva, Luís; Dinis, Paulo; Marques, António Leitão

doi:10.1016/j.thromres.2013.06.025

Cited by 29 publications

(22 citation statements)

References 32 publications

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“…We can identify patients who will benefit from a more potent antithrombotic treatment at discharge. Although our results are striking, they are in line with other studies previously published, such as Barra et al 23 Also this observational retrospective single-centre cohort study, with fewer patients (n=1.711 patients and post-ACS stroke rate of 4.3%) and a shorter follow-up (median 17.4±8.7 months), shows great predictive ability of the 6-month GRACE risk score (c-index 0.782±0.019). In our cohort, we showed there was no difference between GRACE and CHA 2 DS 2 VASc risk scores to predict the risk of stroke after ACS.…”

Section: Discussionsupporting

confidence: 94%

Is 6-month GRACE risk score a useful tool to predict stroke after an acute coronary syndrome?

et al. 2014

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ObjectivesThe risk of stroke after an acute coronary syndrome (ACS) has increased. The aim of this study was to do a comparative validation of the 6-month GRACE (Global Registry of Acute Coronary Events) risk score and CH2DS2VASc risk score to predict the risk of post-ACS ischaemic stroke.MethodsThis was a retrospective study carried out in a single centre with 4229 patients with ACS discharged between 2004 and 2010 (66.9±12.8 years, 27.9% women, 64.2% underwent percutaneous coronary intervention). The primary end point is the occurrence of an ischaemic stroke during follow-up (median 4.6 years, IQR 2.7–7.1 years).Results184 (4.4%) patients developed an ischaemic stroke; 153 (83.2%) had sinus rhythm and 31 (16.9%) had atrial fibrillation. Patients with stroke were older, with higher rates of hypertension, diabetes, previous stroke and previous coronary artery disease. The HR for CHA2DS2VASc was 1.36 (95% CI, 1.27 to 1.48, p<0.001) and for GRACE, HR was 1.02(95% CI, 1.01 to 1.03, p<0.001). Both risk scores show adequate discriminative ability (c-index 0.63±0.02 and 0.60±0.02 for CHA2DS2VASc and GRACE, respectively). In the reclassification method there was no difference (Net Reclassification Improvement 1.98%, p=0.69). Comparing moderate-risk/high-risk patients with low-risk patients, both risk scores showed very high negative predictive value (98.5% for CHA2DS2VASc, 98.1% for GRACE). The sensitivity of CHA2DS2VASc score was higher than the GRACE risk score (95.1% vs 87.0%), whereas specificity was lower (14.4% vs 30.2%).ConclusionsThe 6-month GRACE model is a clinical risk score that facilitates the identification of individual patients who are at high risk of ischaemic stroke after ACS discharge.

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Section: Discussionsupporting

confidence: 94%

Is 6-month GRACE risk score a useful tool to predict stroke after an acute coronary syndrome?

et al. 2014

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“…Piccini et al [22] proposed a modified R-CHA 2 DS 2 -VASc score by adding renal function parameters (glomerular filtration rate and urea), performance of a revascularization procedure, and history of atrial fibrillation. Based on that modified R-CHA 2 DS 2 -VASc score, a study showed a good calibration and high discriminative performance of that score in the prediction of post-discharge ischemic stroke and all-cause mortality [23]. Recently, Podolecki et al [16] studied 2980 patients with acute coronary syndromes and no AF and reported that an increment of one point in the CHA 2 DS 2 -VASc score was independently associated with a 41 % increase in stroke risk and a 23 % increase in mortality rate ( P < 0.001 for both).…”

Section: Discussionmentioning

confidence: 99%

CHA2DS2-VASc score is useful in predicting poor 12-month outcomes following myocardial infarction in diabetic patients without atrial fibrillation

et al. 2016

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AimsTIMI risk score and GRACE risk model are widely available and accepted scores for risk assessment in STEMI patients and include predictors of poor outcomes. CHA2DS2-VASc is a validated score for predicting embolic/stroke risk in patients with non-valvular atrial fibrillation. Its components contribute to the worse prognosis following myocardial infarction. The advantage of the CHA2DS2-VASc score in comparison with other risk scores is that it provides a comprehensive, fast, and simple method for physicians in risk evaluation that requires no calculators or computers. Therefore, we have set out to examine the prognostic significance of CHA2DS2-VASc score following STEMI in diabetic patients without AF.MethodsA total of 472 patients with diabetes mellitus and STEMI undergoing primary PCI were enrolled. Based on the estimated CHA2DS2-VASc score, the study population was divided into three groups: group 1 (N = 111) with a moderate CHA2DS2-VASc score of 2 or 3; group 2 (N = 257) with a high CHA2DS2-VASc score of 4 or 5; and group 3 (N = 104) with a very high CHA2DS2-VASc score of 6 or higher.ResultsIn diabetic patients with STEMI, the median of CHA2DS2-VASc score was 4 (interquartile range 3–5). In-hospital mortality rate was similar across three groups. CHA2DS2-VASc score was not a risk factor of in-hospital mortality. ROC analysis revealed good diagnostic value of CHA2DS2-VASc score in predicting long-term mortality (AUC 0.62 95 % CI 0.57–0.66 P = 0.0003) and stroke (AUC 0.75 95 % CI 0.71–0.79 P = 0.0003), but no value in predicting long-term myocardial infarction. CHA2DS2-VASc score was an independent predictor of 12-month mortality and stroke. One-point increment in CHA2DS2-VASc score was associated with an increase in the risk of 12-month death by 24 % and for 12-month stroke by 101 %. ConclusionsIn diabetic patients with STEMI and no previous AF, median CHA2DS2-VASc score was high (4 points) and predicted 12-month death and stroke. However, it failed to predict in-hospital death and 12-month MI. CHA2DS2-VASc score had a similar discrimination performance in predicting 12-month mortality as TIMI risk score and a better discrimination performance in predicting 12-month stroke than TIMI risk score. Thus, it can serve as an additive tool in identifying high-risk patients that require aggressive management.

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“…En attendant des validations, le score CHA2DS2-VASc pourrait être implémenté par la prise en compte de un ou deux points supplémentaires en cas d'insuffisance rénale. Deux publications récentes ont permis de montrer qu'un score R2-CHADS2 ou R-CHA2DS2-VASc [10] pouvait améliorer la prédiction des événements cardiovasculaires chez ces patients.…”

Section: Marqueurs Bilogiques De L'hemostase:-unclassified

“…'échographie transthoracique:-Une fraction d'éjection ventriculaire gauche (FEVG) normale est associée à l'absence de formation de thrombus dans l'auricule gauche [11]. L'évaluation de la FEVG améliore la capacité de discrimination dans l'utilisation des scores CHADS2et CHA2DS2-VASc en ce qui concerne la détection d'un thrombus atrial gauche [12] et d'autres marqueurs de la stase atriale gauche.…”

Section: Marqueurs Bilogiques De L'hemostase:-unclassified

Biologic and Morphologic Markers of the THR Omembolic Risk in the Atrial Fibrillation.

Jallal.¹,

Zbitou²,

Arioua³

et al. 2017

IJAR

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Stroke prediction with an adjusted R-CHA2DS2VASc score in a cohort of patients with a Myocardial Infarction

Cited by 29 publications

References 32 publications

Is 6-month GRACE risk score a useful tool to predict stroke after an acute coronary syndrome?

Is 6-month GRACE risk score a useful tool to predict stroke after an acute coronary syndrome?

CHA2DS2-VASc score is useful in predicting poor 12-month outcomes following myocardial infarction in diabetic patients without atrial fibrillation

Biologic and Morphologic Markers of the THR Omembolic Risk in the Atrial Fibrillation.

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