Risk Stratification Using the CHADS-VASc Score in Patients with Coronary Heart Disease Undergoing Percutaneous Coronary Intervention; Sub-analysis of SHINANO Registry

Overview

Journal Int J Cardiol Heart Vasc

Date 2017 Aug 9

PMID 28785649

Citations 6

Authors

Hirofumi Hioki

Takashi Miura

Yusuke Miyashita

Hirohiko Motoki

Kentaro Shimada

Masanori Kobayashi

Hiroyuki Nakajima

Hikaru Kimura

Eiichiro Mawatari

Hiroshi Akanuma

Toshio Sato

Souichirou Ebisawa

Uichi Ikeda

Affiliations

Soon will be listed here.

Abstract

Background: CHADS or CHADS-VASc score is used for prediction of stroke in patients with atrial fibrillation (AF). Recently, CHADS score is reported to have prognostic value in acute coronary syndrome without AF. However, clinical validation of CHADS-VASc score for prognostic stratification in coronary heart disease (CHD) without AF remains uncertain. In this study, we evaluate whether CHADS-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 CHADS-VASc score in the remaining 1714 patients (mean age 70 ± 11 years, 23% female) without known AF. To assess the clinical validation of CHADS-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 CHADS-VASc score ≥ 5 compared to 3-4 and 0-2 (14.6% vs. 6.8% vs. 5.3%, < 0.001). In multivariate Cox-regression analysis, CHADS-VASc score was an independent predictor for MACE (hazard ratio 1.26, 95% confidence interval 1.15-1.39 < 0.001).

Conclusions: This study demonstrated that CHADS-VASc score could provide prognostic information in CHD without known AF.

Citing Articles

Coronary artery disease severity and risk stratification of patients with non ST-elevation acute coronary syndrome using CHADS-VASc-HSF score.

Abdelmegid M, Hanna M, Demitry S, Abdelhafez M BMC Cardiovasc Disord. 2024; 24(1):263.

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Prognostic value of CHADS-VASc score for the long-term cardiovascular events after coronary artery bypass grafting.

Ercan A, Gurbuz O, Afsin Culhaoglu Z, Kumtepe G, Ozkan H, Yuksel A Turk Gogus Kalp Damar Cerrahisi Derg. 2023; 31(4):479-488.

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CHA2DS2-VASc Is Associated With In-Hospital Mortality in Patients With Infective Endocarditis: A Cross-Sectional Cohort Study.

Abe T, De Allie G, Eyituoyo H, Abe T, Tobun T, Asotibe J Cureus. 2020; 12(11):e11620.

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Prognostic value of CHADS2 and CHA2DS2-VASc scores for post-discharge outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention.

Ma X, Shao Q, Dong L, Cheng Y, Lv S, Shen H Medicine (Baltimore). 2020; 99(30):e21321.

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The Novel CHADS-VASC-FSH Score is Predictive of Severe Coronary Artery Disease on Coronary Angiography in Patients with Atrial Fibrillation and Unstable Symptoms.

Ciftci O, Yilmaz K, Karacaglar E, Yilmaz M, Ozin B, Muderrisoglu I Eurasian J Med. 2019; 51(2):165-171.

PMID: 31258358 PMC: 6592447. DOI: 10.5152/eurasianjmed.2019.18342.

References

Henriksson K, Farahmand B, Johansson S, Asberg S, Terent A, Edvardsson N . Survival after stroke--the impact of CHADS2 score and atrial fibrillation. Int J Cardiol. 2009; 141(1):18-23. DOI: 10.1016/j.ijcard.2008.11.122. View

Stewart S, Macintyre K, Hole D, Capewell S, McMurray J . More 'malignant' than cancer? Five-year survival following a first admission for heart failure. Eur J Heart Fail. 2001; 3(3):315-22. DOI: 10.1016/s1388-9842(00)00141-0. View

Pancholy S, Shantha G, Patel T, Cheskin L . Sex differences in short-term and long-term all-cause mortality among patients with ST-segment elevation myocardial infarction treated by primary percutaneous intervention: a meta-analysis. JAMA Intern Med. 2014; 174(11):1822-30. DOI: 10.1001/jamainternmed.2014.4762. View

Miura T, Soga Y, Doijiri T, Aihara H, Yokoi H, Iwabuchi M . Prevalence and clinical outcome of polyvascular atherosclerotic disease in patients undergoing coronary intervention. Circ J. 2012; 77(1):89-95. DOI: 10.1253/circj.cj-12-0535. View

Dhamoon M, Tai W, Boden-Albala B, Rundek T, Paik M, Sacco R . Risk of myocardial infarction or vascular death after first ischemic stroke: the Northern Manhattan Study. Stroke. 2007; 38(6):1752-8. DOI: 10.1161/STROKEAHA.106.480988. View

Sacco R, Kasner S, Broderick J, Caplan L, Connors J, Culebras A . An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013; 44(7):2064-89. PMC: 11078537. DOI: 10.1161/STR.0b013e318296aeca. View

Bhatt D, Eagle K, Ohman E, Hirsch A, Goto S, Mahoney E . Comparative determinants of 4-year cardiovascular event rates in stable outpatients at risk of or with atherothrombosis. JAMA. 2010; 304(12):1350-7. DOI: 10.1001/jama.2010.1322. View

Gage B, Waterman A, Shannon W, Boechler M, Rich M, Radford M . Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA. 2001; 285(22):2864-70. DOI: 10.1001/jama.285.22.2864. View

Poci D, Hartford M, Karlsson T, Herlitz J, Edvardsson N, Caidahl K . Role of the CHADS2 score in acute coronary syndromes: risk of subsequent death or stroke in patients with and without atrial fibrillation. Chest. 2011; 141(6):1431-1440. DOI: 10.1378/chest.11-0435. View

10.

Jhund P, Macintyre K, Simpson C, Lewsey J, Stewart S, Redpath A . Long-term trends in first hospitalization for heart failure and subsequent survival between 1986 and 2003: a population study of 5.1 million people. Circulation. 2009; 119(4):515-23. DOI: 10.1161/CIRCULATIONAHA.108.812172. View

11.

Crandall M, Horne B, Day J, Anderson J, Muhlestein J, Crandall B . Atrial fibrillation significantly increases total mortality and stroke risk beyond that conveyed by the CHADS2 risk factors. Pacing Clin Electrophysiol. 2009; 32(8):981-6. DOI: 10.1111/j.1540-8159.2009.02427.x. View

12.

Lewington S, Clarke R, Qizilbash N, Peto R, Collins R . Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002; 360(9349):1903-13. DOI: 10.1016/s0140-6736(02)11911-8. View

13.

Pereira M, Lunet N, Azevedo A, Barros H . Differences in prevalence, awareness, treatment and control of hypertension between developing and developed countries. J Hypertens. 2009; 27(5):963-75. DOI: 10.1097/hjh.0b013e3283282f65. View

14.

Kelly R, Staines A, MacWalter R, Stonebridge P, Tunstall-Pedoe H, Struthers A . The prevalence of treatable left ventricular systolic dysfunction in patients who present with noncardiac vascular episodes: a case-control study. J Am Coll Cardiol. 2002; 39(2):219-24. DOI: 10.1016/s0735-1097(01)01725-9. View

15.

Ning F, Tuomilehto J, Pyorala K, Onat A, Soderberg S, Qiao Q . Cardiovascular disease mortality in Europeans in relation to fasting and 2-h plasma glucose levels within a normoglycemic range. Diabetes Care. 2010; 33(10):2211-6. PMC: 2945162. DOI: 10.2337/dc09-2328. View

16.

Huang S, Chen Y, Chan W, Huang P, Chen J, Lin S . Usefulness of the CHADS2 score for prognostic stratification of patients with acute myocardial infarction. Am J Cardiol. 2014; 114(9):1309-14. DOI: 10.1016/j.amjcard.2014.07.063. View

17.

Friberg L, Rosenqvist M, Lip G . Evaluation of risk stratification schemes for ischaemic stroke and bleeding in 182 678 patients with atrial fibrillation: the Swedish Atrial Fibrillation cohort study. Eur Heart J. 2012; 33(12):1500-10. DOI: 10.1093/eurheartj/ehr488. View

18.

DeLong E, Delong D, Clarke-Pearson D . Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988; 44(3):837-45. View

19.

Lip G, Nieuwlaat R, Pisters R, Lane D, Crijns H . Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest. 2009; 137(2):263-72. DOI: 10.1378/chest.09-1584. View

20.

Miura T, Miyashita Y, Motoki H, Shimada K, Kobayashi M, Nakajima H . In-hospital clinical outcomes of elderly patients (≥80 years) undergoing percutaneous coronary intervention. Circ J. 2014; 78(5):1097-103. DOI: 10.1253/circj.cj-14-0129. View