Prognostic value of CHADS(2) and CHA(2)DS(2)-VASc scores for post-discharge outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention

The CHADS(2) and CHA(2)DS(2)-VASc scores were initially developed to assess the risk of stroke or systemic embolism in patients with atrial fibrillation (AF). Recently, these two scoring systems have been demonstrated to predict long- and short-term cardiovascular (CV) outcomes in many patient cohorts. However, to the best of our knowledge, their prognostic value has not been fully elucidated in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). This study aimed to investigate the association of CHADS(2) and CHA(2)DS(2)-VASc scores with CV outcomes in such patients. We included a total of 915 ACS patients undergoing PCI in this study. CHADS(2) and CHA(2)DS(2)-VASc scores were calculated from data collected before discharge. The primary endpoint was defined as a composite of major adverse CV events (MACE) including overall death, nonfatal stroke, nonfatal myocardial infarction (MI) and unplanned repeat revascularization. We assessed MACE's relationship to CHADS(2) and CHA(2)DS(2)-VASc scores using Cox proportional-hazard regression analyses. Mean follow-up duration was 918 days. MACE occurred in 167 (18.3%) patients. A higher CHADS(2) score was associated with reduced event-free survival (EFS) from MACE (logrank test, P = .007) with differences potentiated if stratified by CHA(2)DS(2)-VASc score (logrank test, P < .001). Univariate analysis showed that both CHADS(2) and CHA(2)DS(2)-VASc scores were good predictors of MACE. In the multivariate Cox proportional-hazard regression analysis, CHA(2)DS(2)-VASc score (hazard ratio [HR], 1.15; 95% confidence interval [CI] 1.04–1.27; P = .007) remained a useful predictor of MACE; however, CHADS(2) score was no longer associated with increased risk of MACE. C-statistics for CHA(2)DS(2)-VASc score, GRACE (Global Registry of Acute Coronary Events) hospital discharge risk score (GRACE Score) and SYNTAX (Synergy between PCI with TAXUS and Cardiac Surgery) Score II (SS II) in predicting MACE were 0.614, 0.598, and 0.609, respectively. CHA(2)DS(2)-VASc score was an independent and significant predictor of MACE in ACS patients undergoing PCI, and its discriminatory performance was not inferior to those of GRACE Score and SS II.