Study of the CHA2DS2-VASc score in acute coronary syndrome
Wednesday, May 22, 2019
Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)
Ahmed Salem Alhaithami
,
mansoura faculty of medicine, mansoura, Egypt
Moheb Magdy Wadie, M.D.
,
mansoura faculty of medicine, Mansoura, Egypt
Ahmed Ahmed Wafa
,
mansoura faculty of medicine, mansoura, Egypt
Mahmoud Abdo Yossof
,
mansoura faculty of medicine, mansoura, Egypt
Background:
To predict outcomes, acute coronary syndrome (ACS) can be assessed using GRACE and TIMI risk scores, whereas SYNTAX score is used to assess coronary artery disease (CAD) severity and clarify the management. CHA2DS2-VASc score is used as a predictive tool for stroke prevention in non-valvular atrial fibrillation, and it was studied in ACS in terms of outcome and CAD severity
Methods
:
125 consecutive ACS patients were enrolled in this observational prospective study between December 2016 and June 2017 in Mansoura specialized medical hospital; 89 patients were followed for six months. mean age was 57.78 (± 9.5) years, and 78.4% of them were males. Patients were assessed based on history, clinical examination, 12-lead ECG, and coronary angiography.
Results:
Subjects with a CHA2DS2-VASc score ≥ 2 had a higher proportion of multivessel disease (3.9%), left main coronary artery lesions (9.9%), and totally occluded, bifurcational, or long coronary lesions (60%) (All p-values<0.05). We found significant associations of the CHA2DS2-VASc score with the SYNTAX score (p<0.001) and the Gensini score (p<0.001). Receiver operating characteristic (ROC) curves were generated and cutoff values determined for the CHA2DS2-VASc score (cutoff>2; 76% sensitivity; 76.8% specificity; p<0.001), SYNTAX score (cutoff≥26; 84% sensitivity; 98.9% specificity; p<0.001), and Gensini score (cutoff>50; 84% sensitivity; 85.7% specificity; p<0.001) in predicting coronary multivessel diseases. Subjects with a CHA2DS2-VASc score ≥ 2 had a higher in-hospital complications (all p-values<0.05). The CHA2DS2-VASc score showed significant associations with in-hospital (11.9%, p=0.21) and six-month mortality (25%, p=0.042). ROC curves were generated and cutoff values determined for the CHA2DS2-VASc score (cutoff>2; 88% sensitivity; 65.3% specificity; p<0.001) in predicting six-month-mortality. Multivariate logistic regression analysis showed that the CHA2DS2-VASc score (p<0.001 with odds ratio 2.28; 95% CI 1.47–3.53) and the GRACE score (p<0.001 with odds ratio 1.07; 95% CI 1.03–1.09) were predictors of six-month mortality.
Conclusions:
The CHA2DS2-VASc score is associated with increased CAD severity and in-hospital and six-month outcomes.
