Background & purposeWe have conducted a retrospective observational study to analyze the correlation between the CHADS2 score, the modified CHA2DS2-VASc (mCHA2DS2-VASc) score, and the incidence of all-cause death and congestive heart failure (CHF).MethodsThe study cohort consisted of 292 consecutive patients with nonvalvular atrial fibrillation (NVAF) admitted to our hospital from 2012 to 2014. Electronic medical records were used to confirm medical history including prior heart failure, hypertension, diabetes, stroke, and coronary disease. A follow-up survey for all-cause deaths and incidence of CHF was carried out from the baseline data to May 2015. We analyzed the correlation between each score and the endpoints using the Kaplan-Meier method and the Cox proportional hazards model.ResultDuring the follow up period (mean=1.6 years), 69 all-cause deaths and 58 CHF events occurred in the cohort. There was no significant association between these scores and all-cause death in our CHF cohort. The incidence of CHF significantly increased along with increased CHADS2 (p=0.018) or mCHA2DS2-VASc scores (p=0.044). The hazard ratio (HR) for CHF after adjustment for drug treatment was obtained from a Cox proportional hazards model. The HRs for the CHADS2 and mCHA2DS2-VASc scores were 1.38 (95% CI; 1.13–1.68) and 1.35 (95% CI; 1.24–1.59), respectively.ConclusionCalculation of the CHADS2 and mCHA2DS2-VASc scores in order to evaluate the risk of systemic thromboembolism was useful to predict the onset of CHF, but not all-cause death, in patients with NVAF.

Acute myocardial infarction in the left main trunk (LM-AMI) is a serious clinical condition with a mortality of at least 20 to 40% 1-3). Although more rapid reperfusion therapy is very important especially in LM-AMI, most in-hospital deaths in patients with LM-AMI are caused by pump failure with extensive myocardial damage in a short period of time. Factors associated with in-hospital death in patients with LM-AMI include cardiogenic shock (CS) 1, 2, 4, 5) , cardiopulmonary resuscitation (CPR) 5) and low glomerular filtration rate (GFR) 2). Among these factors, CS in particular has a large impact on the prognosis of patients 1, 2 4-6). However, no reports have compared patients with or without CS because LM-AMI is relatively rare (2.2% of AMI cases) 7). Especially, it is also unclear what factors in patients without CS are associated with in-hospital death. The authors considered that it is important to clarify differences between the two groups of clinical characteristics on admission to help determine optimal management of medical treatment, including revascularization and assisted circulation devices.