CHA(2)DS(2)-VASc score for in-hospital recurrence risk stratification in patients with myocardial infarction

BACKGROUND: Using the CHA(2)DS(2)-VASc score to recognize the risk of stroke in patients with atrial fibrillation has been well-established. However, few studies have assessed whether the CHA(2)DS(2)-VASc score has a similar predictive value in recurrence after myocardial infarction (MI). METHODS: We conducted a retrospective observational cohort study of adult inpatients with MI. The CHA(2)DS(2)-VASc and modified CHA(2)DS(2)-VASc (MCHA(2)DS(2)-VASc) scores of all patients were calculated. The associations of both scores with recurrent MI were analyzed. RESULTS: A total of 6,700 patients with MI (60.0 ± 11.1 years, 77.2% men) were enrolled, and 759 (11.3%) presented a definite recurrence during hospitalization. After multivariable adjustment by logistic regression in patients with MI, the CHA(2)DS(2)-VASc and MCHA(2)DS(2)-VASc scores were independently associated with recurrence. The MCHA(2)DS(2)-VASc score showed a better predictive value for risk of recurrence than that of CHA(2)DS(2)-VASc in overall [area under the receiver operating characteristic curve (AUC) 0.757 vs. 0.676] or male patients (AUC 0.759 vs. 0.708). MCHA(2)DS(2)-VASc was superior to CHA(2)DS(2)-VASc for identifying “truly high-risk” patients with MI, regardless of overall patients or sex-specific subgroups. The two scores had a similar focus on the identification of “low-risk” patients in overall or women, but not in men. CONCLUSION: The CHA(2)DS(2)-VASc and MCHA(2)DS(2)-VASc scores for predicting recurrence are validated in patients with MI. However, MCHA(2)DS(2)-VASc could be more helpful to secondary prevention than CHA(2)DS(2)-VASc after MI, especially in men. The superiority of MCHA(2)DS(2)-VASc compared with CHA(2)DS(2)-VASc in women is just more discriminatory for “truly high-risk” patients.