Prediction of acute-coronary-syndrome using newly-defined R2-CHA2DS2-VASc score among patients with chest pain

Topaz, Guy; Ben-Zvi, Elad; Pereg, David; Kitay-Cohen, Yona; Benchetrit, Sydney; Zitman‐Gal, Tali; Shilo, Lotan; Cohen-Hagai, Keren

doi:10.1016/j.jjcc.2020.08.013

Cited by 4 publications

(3 citation statements)

References 15 publications

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“…Accordingly, we used those eGFR cutoff levels for the M-R 2 CHA 2 DS 2 -VASc in our study. We categorized patients into three groups according to the score, as previously described [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…The modified R 2 CHA 2 DS 2 -VASc score was calculated by assigning one point each for the presence of: congestive heart failure, hypertension, diabetes mellitus, vascular disease and age 65–74 years, and two points for age older than 75 years and history of stroke or transient ischemic attack. GFR above 60 ml/min was given 0 points, GFR 30–60 ml/min was given 1 point and GFR below 30 ml/min was given 2 points [ 14 ] (Table 1 ).…”

Section: Methodsmentioning

confidence: 99%

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Mortality prediction using a modified R2CHA2DS2-VASc score among hospitalized COVID-19 patients

et al. 2022

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The CHA 2 DS 2 -VASc score incorporates several comorbidities which have prognostic implications in COVID-19. We assessed whether a modified score (M-R 2 CHA 2 DS 2 -VASc), which includes pre-admission kidney function and male sex, could be used to classify mortality risk among people hospitalized with COVID-19. This retrospective study included adults admitted for COVID-19 between March and December 2020. Pre-admission glomerular filtration rate (GFR) was calculated based on serum creatinine and used for scoring M-R 2 CHA 2 DS 2 -VASc. Participants were categorized according to the M-R 2 CHA 2 DS 2 -VASc categories as 0–1 (low), 2–3 (intermediate), or ≥ 4 (high), and according to initial COVID-19 severity score. The primary outcome was 30-day mortality rates. Secondary outcomes were mortality rates over time, and rates of mechanical ventilation, hemodynamic support, and renal replacement therapy. Eight hundred hospitalizations met the study criteria. Participants were 55% males, average age was 65.2 ± 17 years. There were similar proportions of subjects across the M-R 2 CHA 2 DS 2 -VASc categories. 30-day mortality was higher in those in higher M-R 2 CHA 2 DS 2 -VASc category and with severe or critical COVID-19 at admission. Subjects in the low, intermediate, and high M-R 2 CHA 2 DS 2 -VASc categories had 30-day mortality rates of 4.7%, 17% and 31%, respectively ( p < 0.001). Higher category was also associated with increased need for mechanical ventilation and renal replacement therapy. All-cause 90-day mortality remained significantly associated with M-R 2 CHA 2 DS 2 -VASc. The M-R 2 CHA 2 DS 2 -VASc score is associated with 30-day mortality rates among patients hospitalized with COVID-19, and adds predictive value when combined with initial COVID-19 severity.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Mortality prediction using a modified R2CHA2DS2-VASc score among hospitalized COVID-19 patients

et al. 2022

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“…The CHA 2 DS 2 -VASc score was calculated at admission to hospital for all patients by evaluating the following parameters [ 6 ]: presence/history of congestive heart failure, hypertension, age, diabetes mellitus, stroke or transient ischemic attack, vascular disease, sex. We also calculated the R 2 CHA 2 DS 2 -VASc score by adding 2 points to the CHA 2 DS 2 -VASc score for patients with eGFR < 60 ml/min/1.73 m 2 [ 11 ].…”

Section: Methodsmentioning

confidence: 99%

CHA2DS2-VASc score as a predictor of clinical outcomes in hospitalized patients with and without chronic kidney disease

Gigante,

Imbimbo,

Andreini

et al. 2023

J Nephrol

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Background High CHA2DS2-VASc score (Congestive heart failure, Hypertension, Age > 75 years, Diabetes mellitus, prior Stroke or transient ischemic attack or thromboembolism, Vascular disease, Age 65–74 and Sex category) was associated with adverse clinical outcomes in different settings. The aim of the present study was to evaluate the association between CHA2DS2-VASc score and R2CHA2DS2-VASc score (which includes renal impairment) with in-hospital mortality and length of hospital stay in patients hospitalized in an internal medicine ward. Methods We enrolled 983 consecutive patients admitted during 3 years in an internal medicine ward. R2CHA2DS2-VASc score was calculated by adding 2 points to CHA2DS2-VASc for the presence of chronic kidney disease (CKD), defined according to K-DOQI. The primary outcome was a composite of all-cause mortality and length of hospital stay > 10 days. Results Patients with CKD stages 3–5 presented with increased CHA2DS2-VASc vs stages 1–2 (p < 0.001). The composite outcome occurred in 47.3% of inpatients. Multivariable linear logistic regression analyses adjusted for presence of infectious diseases and cancer, with the occurrence of composite outcome showed an adjusted OR of 1.349 (95% CI 1.248–1.462) and 1.254 (95% CI 1.179–1.336) for CHA2DS2-VASc and R2CHA2DS2-VASc scores, respectively. No differences were found in the association between CHA2DS2-VASc and R2CHA2DS2-VASc scores with the composite outcome (AUC 0.631 vs 0.630), and furthermore, adding the presence/absence of infectious diseases during hospitalization and positive cancer history to the models increased the AUC (0.667 and 0.663). Conclusions Incrementally higher CHA2DS2-VASc score is associated with increased length of hospital stay and mortality in patients hospitalized in an internal medicine ward, regardless of the presence of CKD. Graphical abstract

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Atrial high-rate episodes intensify R2CHA2DS2-VASc score for prognostic stratification in pacemaker patients

Chen

et al. 2023

Sci Rep

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Patients with device detected atrial high-rate episodes (AHRE) have an increased risk of MACE. The R2CHA2DS2-VASc, CHADS2, R2CHADS2 and CHA2DS2-VASc score have been investigated for predicting major adverse cardiovascular events (MACE) in different groups of patients. We aimed to evaluate the R2CHA2DS2-VASc score in combination with AHRE ≥ 6 min for predicting MACE in patients with dual-chamber PPM but no prior atrial fibrillation (AF). We retrospectively enrolled 376 consecutive patients undergoing dual-chamber PPM implantation and no prior AF. The primary endpoint was subsequent MACE. For all patients in the cohort, CHADS2, R2CHADS2, CHA2DS2-VASc, R2CHA2DS2-VASc scores and AHRE ≥ or < 6 min were determined. AHRE was recorded as a heart rate > 175 bpm (Medtronic) or > 200 bpm (Biotronik) lasting ≥ 30 s. Multivariate Cox regression analysis with time-dependent covariates was used to determine the independent predictors of MACE. ROC-AUC analysis was performed for CHADS2, R2CHADS2, CHA2DS2-VASc, and R2CHA2DS2-VASc scores and then adding AHRE ≥ 6 min to the four scores. The median age was 77 years, and 107 patients (28.5%) developed AHRE ≥ 6 min. After a median follow-up of 32 months, 46 (12.2%) MACE occurred. Multivariate Cox regression analysis showed that R2CHA2DS2-VASc score (HR, 1.485; 95% CI, 1.212–1.818; p < 0.001) and AHRE ≥ 6 min (HR, 2.125; 95% CI, 1.162–3.887; p = 0.014) were independent predictors for MACE. The optimal R2CHA2DS2-VASc score cutoff value was 4.5 (set at ≥ 5), with the highest Youden index (AUC, 0.770; 95% CI, 0.709–0.831; p < 0.001). ROC-AUC analysis of the four risk scores separately combined with AHRE ≥ 6 min all showed better discriminatory power than the four scores alone (All Z-statistic p < 0.05). In patients with PPM who develop AHRE ≥ 6 min, it is crucial to perform risk assessment with either four scores to further stratify risk for MACE.

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Prediction of acute-coronary-syndrome using newly-defined R2-CHA2DS2-VASc score among patients with chest pain

Cited by 4 publications

References 15 publications

Mortality prediction using a modified R2CHA2DS2-VASc score among hospitalized COVID-19 patients

Mortality prediction using a modified R2CHA2DS2-VASc score among hospitalized COVID-19 patients

CHA2DS2-VASc score as a predictor of clinical outcomes in hospitalized patients with and without chronic kidney disease

Atrial high-rate episodes intensify R2CHA2DS2-VASc score for prognostic stratification in pacemaker patients

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