CHA2DS2-VASc-HS score in non-ST elevation acute coronary syndrome patients: assessment of coronary artery disease severity and complexity and comparison to other scoring systems in the prediction of in-hospital major adverse cardiovascular events

Abstract

Objective:We recently described the CHA2DS2-VASc-HS score as a novel predictor of coronary artery disease (CAD) severity in stable CAD patients. We aimed to assess the accuracy of the CHA2DS2-VASc-HS score in the determination of CAD severity and complexity and its availability in the risk stratification of in-hospital major adverse cardiovascular events (MACE) in non-ST elevation acute coronary syndrome (NSTE-ACS) patients.Methods:We prospectively analyzed the clinical and angiographic data of consecutive NSTE-ACS patients in our clinic. Patients were classified into three tertiles according to their SYNTAX score (SS): tertile 1 had an SS of 0–22; tertile 2 had an SS of 23–32; and tertile 3 had an SS of >32. There were no specific exclusion criteria except for previous coronary artery bypass grafting (CABG) because SS was validated for only native coronary arteries for this study. We used the following analyses: χ2 or Fisher’s exact tests, one-way analysis of variance or Kruskal–Wallis tests, Pearson’s or Spearman’s tests, the receiver operating characteristics (ROC) curve analysis, the area under the curve (AUC) or C-statistic, and pairwise comparisons of the ROC curves.Results:A total of 252 patients were enrolled. There were 131 patients in tertile 1, 79 in tertile 2, and 42 in tertile 3. The number of diseased vessels was correlated with the Global Registry for Acute Coronary Events (GRACE) (p<0.001), Thrombolysis in Myocardial Infarction (TIMI) (p<0.001), and CHA2DS2-VASc-HS (p<0.001) scores. In the ROC curve analyses, the cut-off value of the CHA2DS2-VASc-HS score in the prediction of in-hospital MACE was >5 with a sensitivity of 69.6% and specificity of 90.3% (AUC: 0.804, 95%: CI 0.750–0.851, p<0.001). We also compared the diagnostic accuracy of the CHA2DS2-VASc-HS score with the TIMI and GRACE risk scores in the determination of the in-hospital MACE and found no differences.Conclusion:The CHA2DS2-VASc-HS score was positively correlated with the severity and complexity of CAD. We also found that CHA2DS2-VASc-HS was comparable with other risk scores for the risk stratification of the in-hospital MACE of NSTE-ACS patients. Therefore, it may play an important role as a predictive model of NSTE-ACS patients in clinical practice. (Anatol J Cardiol 2016; 16: 742-8)

Association of CHA2DS2-VASc-HS Score with Adverse In-hospital Outcomes in Patients with Non-ST Segment Elevation Myocardial Infarction

“…In a similar study Taºolar, et al found 23.2% patients with cardiac events in patients with CHA2DS2-VASc-HS >4 compared to 3.8% in score ≤4. 16 The findings of this study were consistent with the previous study. Risk was measured by relative risk (RR).…”

“…Total cholesterol and triglyceride level had higher in group II than group I but did not reach the level of significance (p>0.05). 16 HDL cholesterol was lower in group I than group II with no statistical difference. Among biochemical parameters only cardiac troponin level were found higher in group I compared to group II and reached the level of significance.…”

“…15 Another study compared the CHA2DS2-VASc-HS score with the TIMI and GRACE risk score, which have no differences. 16 The purpose of this study is to evaluate the association of CHA2DS2-VASc-HS score in prediction of adverse in-hospital outcomes in patients with NSTEMI. This scoring is an easily remembered formula that includes multiple risk factors, which is practical, simple, and useful.…”

Role of CHA2DS2-VASc-HS Score as Predictor for Failed Reperfusion After Fibrinolytic in St-Elevation Myocardial Infarction

“…Many studies have used the CHA 2 DS 2 -VASc-HS score on coronary heart disease, as the study by Cetin et al (2014) found that the CHA 2 DS 2 -VASc-HS score > 2 was a predictor of coronary heart disease severity. 9 The same study was developed by Tasolar et al (2016) also mentioned that the CHA 2 DS 2 -VASc-HS score > 5 could be a predictor of severity and complexity of coronary artery disease and predictors of major cardiovascular events in NSTEMI patients. 17 Both of these studies were important and significant because the components in the CHA 2 DS 2 -VASc-HS score which were hypertension, older age, diabetes mellitus, male gender, hyperlipidemia and smoking are very important traditional risk factors for coronary heart disease and are prognostic factors in cardiovascular outcome.…”

Risk Stratification for Acute Pulmonary Embolism in Patients with Atrial Fibrillation: Role of CHADS2 Score

“…7 CHA 2 DS 2 -VASc score was also widely used to predict severity and outcome of coronary artery disease with or without AF. [14][15][16] CHA 2 DS 2 -VASc score has also been applied in PE. A total of 73,541 adults with AF and without PE were followed-up for 1 year.…”