Journal Article

Use of CHADS2 and CHA2DS2-VASc Scores to Predict Subsequent Myocardial Infarction, Stroke, and Death in Patients with Acute Coronary Syndrome: Data from Taiwan Acute Coronary Syndrome Full Spectrum Registry

Lo, Huey-Ming, Chiu, Chiung-Zuan, Shyu, Kou-Gi, Chua, Su-Kiat

2014

Overview

Acute coronary syndrome (ACS) patients have a wide spectrum of risks for subsequent cardiovascular events and death. However, there is no simple, convenience scoring system to identify risk of adverse outcomes. We investigated whether CHADS₂ and CHA₂DS₂-VASc scores were useful tools to assess the risk for adverse events among ACS patients. This observational prospective study was conducted at 39 hospitals. Totally 3,183 patients with ACS were enrolled, and CHADS₂ and CHA₂DS₂-VASc scores were calculated. The primary endpoint was occurrence of adverse event, including subsequent myocardial infarction, stroke, or death, within 1 year of discharge. CHADS₂ and CHA₂DS₂-VASc scores were significant predictors of adverse events in separate multivariate regression analyses. A Kaplan-Meier analysis of CHADS₂ and CHA₂DS₂-VASc scores of ≥2 showed a higher rate of adverse events as compared with scores of <2 (P<0.001;log-rank test). CHA₂DS₂-VASc score was better than CHADS₂ score in predicting subsequent adverse events; the area under the receiver operating characteristic curve increased from 0.66 to 0.70 (p<0.001). Patients with CHADS₂ scores of 0 or 1 were further classified according to CHA₂DS₂-VASc score, using a cutoff value of 2. The rate of adverse events significantly differed between those with a score of <2 and those with a score of ≥2 (4.1% vs.10.7%, P<0.001). CHADS₂ and CHA₂DS₂-VASc scores were useful predictors of subsequent adverse events in ACS patients.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Acute Coronary Syndrome - diagnosis / Acute Coronary Syndrome - epidemiology / Acute coronary syndromes / Adult / Age / Aged / Aged, 80 and over / Angina pectoris / Cardiac arrhythmia / Cardiology / Cardiovascular disease / Cerebral infarction / Clinical outcomes / Death / Diabetes / Female / Follow-Up Studies / Health risks / Heart attacks / Heart failure / Hospitals / Humans / Hypertension / Internal medicine / Kaplan-Meier Estimate / Male / Medical prognosis / Medicine / Medicine and Health Sciences / Middle Aged / Mortality / Myocardial infarction / Myocardial Infarction - diagnosis / Myocardial Infarction - epidemiology / Patients / Prognosis / Registries / Regression analysis / Risk assessment / Risk Factors / ROC Curve / Stroke / Stroke - diagnosis / Stroke - epidemiology / Taiwan - epidemiology / Thromboembolism / Treatment Outcome / Trends / Wu Ho-Su / Young Adult