Usefulness of the CHA2DS2-VASc Score to Predict Adverse Outcomes in Acute Coronary Syndrome Patients Without Atrial Fibrillation Undergoing Percutaneous Coronary Intervention

Peng, Hui; Sun, Zhijun; Chen, Hui; Zhang, Yue; Ding, Xiaosong; Zhao, Xue-Qiao; Li, Hongwei

doi:10.1016/j.amjcard.2019.05.036

Cited by 15 publications

(21 citation statements)

References 24 publications

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“…11 In recent years, several studies have suggested that CHADS2, R2CHADS2, and CHA2DS2-VASc could predict new occurrence of AF in the general population, [12][13][14][15] patients after AF ablation, 16 or patients with acute coronary syndrome. 17,18 In addition, the individual components in these scores are also the potential risk factors of AF in HF patients. Therefore, it would be interesting to determine if the CHADS2, R2CHADS2, and CHA2DS2-VASc scores could predict AF in HFpEF patients.…”

Section: Introductionmentioning

confidence: 99%

“…The R2CHADS2 score, established by adding creatinine clearance (doubled) into the CHADS2 score, seemingly could improve the predictive ability of stroke in patients with AF 11 . In recent years, several studies have suggested that CHADS2, R2CHADS2, and CHA2DS2‐VASc could predict new occurrence of AF in the general population, 12–15 patients after AF ablation, 16 or patients with acute coronary syndrome 17,18 . In addition, the individual components in these scores are also the potential risk factors of AF in HF patients.…”

Section: Introductionmentioning

confidence: 99%

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Usefulness of CHADS2, R2CHADS2, and CHA2DS2‐VASc scores for predicting incident atrial fibrillation in heart failure with preserved ejection fraction patients

Xie

Liang

et al. 2021

ESC Heart Failure

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Aims Coexisting of atrial fibrillation (AF) in patients with heart failure with preserved ejection fraction (HFpEF) could increase the risk of mortality. In this study, we aimed to assess the values of the CHADS2, R2CHADS2, and CHA2DS2-VASc scores for AF prediction in HFpEF patients. Methods and results We performed a retrospective analysis on symptomatic HFpEF patients in the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist) trial. Associations of the CHADS2, R2CHADS2, and CHA2DS2-VASc scores with the risk of incident AF in HFpEF patients without baseline AF (n = 2202) were assessed using the multivariable competing risk regression models. The discriminatory performances of these scores were calculated using the C-index. During a median follow-up of 3.3 years, the average incidence of AF was 1.80 per 100 patient-years in HFpEF patients. When score was analysed as a continuous variable, per 1-point increase in the CHADS2 (hazard ratio [

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Usefulness of CHADS2, R2CHADS2, and CHA2DS2‐VASc scores for predicting incident atrial fibrillation in heart failure with preserved ejection fraction patients

Xie

Liang

et al. 2021

ESC Heart Failure

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“…Although the CHA 2 DS 2 -VASc score is used and validated in AF patients [ 9 , 10 ], there is limited evidence for validity of the CHA 2 DS 2 -VASc score in patients with AF following PCI [ 11 ]. Therefore, it remains unclear if the score is useful to predict bleeding and ischaemic outcomes in this subset of patients.…”

Section: Introductionmentioning

confidence: 99%

Clinical risk predictors in atrial fibrillation patients following successful coronary stenting: ENTRUST-AF PCI sub-analysis

et al. 2020

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Aims This subgroup analysis of the ENTRUST-AF PCI trial (ClinicalTrials.gov Identifier: NCT02866175; Date of registration: August 2016) evaluated type of AF, and CHA2DS2-VASc score parameters as predictors for clinical outcome. Methods Patients were randomly assigned after percutaneous coronary intervention (PCI) to either edoxaban (60 mg/30 mg once daily [OD]; n = 751) plus a P2Y12 inhibitor for 12 months or a vitamin K antagonist [VKA] (n = 755) plus a P2Y12 inhibitor and aspirin (100 mg OD, for 1–12 months). The primary outcome was a composite of major/clinically relevant non-major bleeding (CRNM) within 12 months. The composite efficacy endpoint consisted of cardiovascular death, stroke, systemic embolic events, myocardial infarction (MI), and definite stent thrombosis. Results Major/CRNM bleeding event rates were 20.7%/year and 25.6%/year with edoxaban and warfarin, respectively (HR [95% CI]: 0.83 [0.654–1.047]). The event rates of composite outcome were 7.26%/year and 6.86%/year, respectively (HR [95% CI]): 1.06 [0.711–1.587]), and of overall net clinical benefit were 12.48%/year and 12.80%/year, respectively (HR [(95% CI]: 0.99 [(0.730; 1.343]). Increasing CHA2DS2-VASc score was associated with increased rates of all outcomes. CHA2DS2-VASc score ≥ 5 was a marker for stent thrombosis. Paroxysmal AF was associated with a higher occurrence of MI (4.87% versus 2.01%, p = 0.0024). Conclusion After PCI in AF patients, increasing CHA2DS2-VASc score was associated with increased bleeding rates and CHA2DS2-VASc score (≥ 5) predicted the occurrence of stent thrombosis. Paroxysmal AF was associated with MI. These findings may have important clinical implications in AF patients.

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“…In this population, the CHA2DS2-VASc showed a moderate predictive capacity for 2-year mortality (C-statistic of 0.66). Moreover, Peng et al [16] showed that the CHA2DS2-VASc score was significantly correlated with both inhospital and long-term (33 months) adverse events in a population of ACS patients undergoing PCI and without AF.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, although several scoring systems have been developed in order to predict early MACE occurrence in ACS patients [7-10], most of them are complex, some requiring web-based calculators, have been specifically developed in non-ST-elevation ACS (NSTE-ACS) or STEMI (ST-elevation myocardial infarction) populations and do not assess as well the long-term risk of these patients. Based on these observations, these simple scores containing only demographic and clinical information have been evaluated in patients with CAD and with ACS, regardless the presence of AF [11-16]. Accounting for the strong relationship between renal function impairment and the cardiovascular thrombotic risk [17-19], the R2-CHADS2 score has been proposed in order to improve the risk prediction by the addition of renal functional status to the original risk model, providing a better predictive performance than the original CHADS2 score [20-22].…”

Section: Introductionmentioning

confidence: 99%

Incremental Value of Renal Dysfunction Addition to the CHA2DS2-Vasc Score for Mortality Prediction in Patients with Acute Coronary Syndrome

et al. 2021

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Introduction: This study analyzes the usefulness of the CHA2DS2-VASc score for mortality prediction in patients with acute coronary syndromes (ACSs) and evaluates if the addition of renal functional status could improve its predictive accuracy. Methods: CHA2DS2-VASc score was calculated by using both the original scoring system and adding renal functional status using 3 alternative renal dysfunction definitions (CHA2DS2-VASc-R1: eGFR <60 mL/min/1.73 mq = 1 point; CHA2DS2-VASc-R2: eGFR <60 mL/min/1.73 mq = 2 points; and CHA2DS2-VASc-R3: eGFR <60 mL/min/1.73 mq = 1 point, <30 mL/min/1.73 mq = 2 points). Inhospital mortality (IHM) and post-discharge mortality (PDM) were recorded, and discrimination of the various risk models was evaluated. Finally, the net reclassification index (NRI) was calculated to compare the mortality risk classification of the modified risk models with that of the original score. Results: Nine hundred and eight ACS patients (median age 68 years, 30% female, 51% ST-elevation) composed the study population. Of the 871 patients discharged, 865 (99%) completed a 12-month follow-up. The IHM rate was 4.1%. The CHA2DS2-VASc score demonstrated a good discriminative performance for IHM (C-statistic 0.75). Although all the eGFR-modified risk models showed higher C-statistics than the original model, a statistically significant difference was observed only for CHA2DS2-VASc-R3. The PDM rate was 4.5%. The CHA2DS2-VASc C-statistic for PDM was 0.75, and all the modified risk models showed significantly higher C-statistics values than the original model. The NRI analysis showed similar results. Conclusions: CHA2DS2-VASc score demonstrated a good predictive accuracy for IHM and PDM in ACS patients. The addition of renal dysfunction to the original score has the potential to improve identification of patients at the risk of death.

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Usefulness of the CHA2DS2-VASc Score to Predict Adverse Outcomes in Acute Coronary Syndrome Patients Without Atrial Fibrillation Undergoing Percutaneous Coronary Intervention

Cited by 15 publications

References 24 publications

Usefulness of CHADS2, R2CHADS2, and CHA2DS2‐VASc scores for predicting incident atrial fibrillation in heart failure with preserved ejection fraction patients

Usefulness of CHADS2, R2CHADS2, and CHA2DS2‐VASc scores for predicting incident atrial fibrillation in heart failure with preserved ejection fraction patients

Clinical risk predictors in atrial fibrillation patients following successful coronary stenting: ENTRUST-AF PCI sub-analysis

Incremental Value of Renal Dysfunction Addition to the CHA2DS2-Vasc Score for Mortality Prediction in Patients with Acute Coronary Syndrome

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