Risk stratification using the CHA(2)DS(2)-VASc score in patients with coronary heart disease undergoing percutaneous coronary intervention; sub-analysis of SHINANO registry()

BACKGROUND: CHADS(2) or CHA(2)DS(2)-VASc score is used for prediction of stroke in patients with atrial fibrillation (AF). Recently, CHADS(2) score is reported to have prognostic value in acute coronary syndrome without AF. However, clinical validation of CHA(2)DS(2)-VASc score for prognostic stratification in coronary heart disease (CHD) without AF remains uncertain. In this study, we evaluate whether CHA(2)DS(2)-VASc score could predict clinical outcome in CHD without known AF. METHODS: SHINANO registry was a prospective, observational, multicenter cohort study, enrolling 1923 consecutive patients with CHD from August 2012 to July 2013. Two hundred nine patients were excluded because of known AF. We calculated CHA(2)DS(2)-VASc score in the remaining 1714 patients (mean age 70 ± 11 years, 23% female) without known AF. To assess the clinical validation of CHA(2)DS(2)-VASc score, we divided patients into 3 groups according to the tertiles (score 0–2, 3–4, and ≥ 5). The primary endpoint was MACE including death, nonfatal myocardial infarction, and ischemic stroke at 1 year. RESULTS: One-year follow-up was completed in 1632 patients (95.2%). Cumulative incidence of MACE was 139 cases. In Kaplan–Meier analysis, incidence of MACE was significantly higher in patients with CHA(2)DS(2)-VASc score ≥ 5 compared to 3–4 and 0–2 (14.6% vs. 6.8% vs. 5.3%, p < 0.001). In multivariate Cox-regression analysis, CHA(2)DS(2)-VASc score was an independent predictor for MACE (hazard ratio 1.26, 95% confidence interval 1.15–1.39p < 0.001). CONCLUSIONS: This study demonstrated that CHA(2)DS(2)-VASc score could provide prognostic information in CHD without known AF.