CHA(2)DS(2)-VASc score is useful in predicting poor 12-month outcomes following myocardial infarction in diabetic patients without atrial fibrillation

AIMS: TIMI risk score and GRACE risk model are widely available and accepted scores for risk assessment in STEMI patients and include predictors of poor outcomes. CHA(2)DS(2)-VASc is a validated score for predicting embolic/stroke risk in patients with non-valvular atrial fibrillation. Its components contribute to the worse prognosis following myocardial infarction. The advantage of the CHA(2)DS(2)-VASc score in comparison with other risk scores is that it provides a comprehensive, fast, and simple method for physicians in risk evaluation that requires no calculators or computers. Therefore, we have set out to examine the prognostic significance of CHA(2)DS(2)-VASc score following STEMI in diabetic patients without AF. METHODS: A total of 472 patients with diabetes mellitus and STEMI undergoing primary PCI were enrolled. Based on the estimated CHA(2)DS(2)-VASc score, the study population was divided into three groups: group 1 (N = 111) with a moderate CHA(2)DS(2)-VASc score of 2 or 3; group 2 (N = 257) with a high CHA(2)DS(2)-VASc score of 4 or 5; and group 3 (N = 104) with a very high CHA(2)DS(2)-VASc score of 6 or higher. RESULTS: In diabetic patients with STEMI, the median of CHA(2)DS(2)-VASc score was 4 (interquartile range 3–5). In-hospital mortality rate was similar across three groups. CHA(2)DS(2)-VASc score was not a risk factor of in-hospital mortality. ROC analysis revealed good diagnostic value of CHA(2)DS(2)-VASc score in predicting long-term mortality (AUC 0.62 95 % CI 0.57–0.66 P = 0.0003) and stroke (AUC 0.75 95 % CI 0.71–0.79 P = 0.0003), but no value in predicting long-term myocardial infarction. CHA(2)DS(2)-VASc score was an independent predictor of 12-month mortality and stroke. One-point increment in CHA(2)DS(2)-VASc score was associated with an increase in the risk of 12-month death by 24 % and for 12-month stroke by 101 %. CONCLUSIONS: In diabetic patients with STEMI and no previous AF, median CHA(2)DS(2)-VASc score was high (4 points) and predicted 12-month death and stroke. However, it failed to predict in-hospital death and 12-month MI. CHA(2)DS(2)-VASc score had a similar discrimination performance in predicting 12-month mortality as TIMI risk score and a better discrimination performance in predicting 12-month stroke than TIMI risk score. Thus, it can serve as an additive tool in identifying high-risk patients that require aggressive management.