Predictive value of CHADS(2) and CHA(2)DS(2)-VASc scores for acute myocardial infarction in patients with atrial fibrillation

The presence of acute myocardial infarction (AMI) confers a poor prognosis in atrial fibrillation (AF), associated with increased mortality dramatically. This study aimed to evaluate the predictive value of CHADS(2) and CHA(2)DS(2)-VASc scores for AMI in patients with AF. This retrospective study enrolled 5140 consecutive nonvalvular AF patients, 300 patients with AMI and 4840 patients without AMI. We identified the optimal cut-off values of the CHADS(2) and CHA(2)DS(2)-VASc scores each based on receiver operating characteristic curves to predict the risk of AMI. Both CHADS(2) score and CHA(2)DS(2)-VASc score were associated with an increased odds ratio of the prevalence of AMI in patients with AF, after adjustment for hyperlipidaemia, hyperuricemia, hyperthyroidism, hypothyroidism and obstructive sleep apnea. The present results showed that the area under the curve (AUC) for CHADS(2) score was 0.787 with a similar accuracy of the CHA(2)DS(2)-VASc score (AUC 0.750) in predicting “high-risk” AF patients who developed AMI. However, the predictive accuracy of the two clinical-based risk scores was fair. The CHA(2)DS(2)-VASc score has fair predictive value for identifying high-risk patients with AF and is not significantly superior to CHADS(2) in predicting patients who develop AMI.