Use of CHADS(2) and CHA(2)DS(2)-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

BACKGROUND: 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 CHADS(2) and CHA(2)DS(2)-VASc scores were useful tools to assess the risk for adverse events among ACS patients. METHODS: This observational prospective study was conducted at 39 hospitals. Totally 3,183 patients with ACS were enrolled, and CHADS(2) and CHA(2)DS(2)-VASc scores were calculated. The primary endpoint was occurrence of adverse event, including subsequent myocardial infarction, stroke, or death, within 1 year of discharge. RESULTS: CHADS(2) and CHA(2)DS(2)-VASc scores were significant predictors of adverse events in separate multivariate regression analyses. A Kaplan-Meier analysis of CHADS(2) and CHA(2)DS(2)-VASc scores of ≥2 showed a higher rate of adverse events as compared with scores of <2 (P<0.001;log-rank test). CHA(2)DS(2)-VASc score was better than CHADS(2) 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 CHADS(2) scores of 0 or 1 were further classified according to CHA(2)DS(2)-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). CONCLUSIONS: CHADS(2) and CHA(2)DS(2)-VASc scores were useful predictors of subsequent adverse events in ACS patients.