Coronary Artery Disease Severity and Risk Stratification of Patients with Non ST-elevation Acute Coronary Syndrome Using CHADS-VASc-HSF Score

Overview

Journal BMC Cardiovasc Disord

Publisher Biomed Central

Specialty Cardiology & Vascular Diseases

Date 2024 May 21

PMID 38773382

Authors

Mohamed Aboel-Kassem F Abdelmegid

Mariam Essa Fares Hanna

Salwa R Demitry

Mohamed Aly Hassan Abdelhafez

Affiliations

Soon will be listed here.

Abstract

Background: Risk stratification assessment of patients with non-ST elevation acute coronary syndrome (NSTE ACS) plays an important role in optimal management and defines the patient's prognosis. This study aimed to evaluate the ability of CHADS-VASc-HSF score (comprising of the components of the CHADS-VASc score with a male instead of female sex category, hyperlipidemia, smoking, and family history of coronary artery disease respectively) to predict the severity and complexity of CAD and its efficacy in stratification for major adverse cardiovascular events (MACE) in patients with NSTE ACS without known atrial fibrillation.

Methods: This study included 200 patients (males 72.5%, mean age 55.8 ± 10.1 years) who were admitted with NSTE ACS. CHADS-VASC-HSF score was calculated on admission. Patients were classified into three groups according to their CHADS-VASC-HSF score: low score group (< 2; 29 patients), intermediate score group (2-4; 83 patients), and high score group (≥ 5; 88 patients). Coronary angiography was conducted and the Syntax score (SS) was calculated. Clinical follow-up at 6 months of admission for the development of MACE was recorded.

Results: SS was significantly high in the high CHADS-VASc-HSF score group compared with low and intermediate score groups. CHADS-VASc-HSF score had a significant positive strong correlation with syntax score (r = 0.64, P < 0.001). Smoking, vascular disease, hyperlipidemia, and CHADS-VASc-HSF score were independent predictors of high SS. For the prediction of severe and complex CAD, CHADS-VASc-HSF score had a good predictive power at a cut-off value ≥ 5 with a sensitivity of 86% and specificity of 65%. Hypertension, vascular disease, high SS, and CHADS-VASc-HSF score were independent predictors of MACE. CHADS-VASC-HSF score ≥ 4 was identified as an effective cut-off point for the development of MACE with 94% sensitivity and 70% specificity.

Conclusions: CHADS-VASC-HSF score is proposed to be a simple bedside score that could be used for the prediction of the severity and complexity of CAD as well as a risk stratification tool for the development of MACE in NSTE ACS patients.

References

Tasolar H, Cetin M, Balli M, Bayramoglu A, Otlu Y, Turkmen S . CHA2DS2-VASc-HS score in non-ST elevation acute coronary syndrome patients: assessment of coronary artery disease severity and complexity and comparison to other scoring systems in the prediction of in-hospital major adverse cardiovascular events. Anatol J Cardiol. 2016; 16(10):742-748. PMC: 5324933. DOI: 10.14744/AnatolJCardiol.2015.6593. View

Rahim M, Uddin M, Jahan J, Chowdhury T, Momen A, Islam M . Prediction of Coronary Artery Disease Severity by Using CHA2DS2-VASC-HSF Score in Patients with ST-Elevation Myocardial Infarction. Mymensingh Med J. 2023; 32(2):393-402. View

Aydinyilmaz F, Ozbeyaz N, Guliyev I, Algul E, Sahan H, Kalkan K . Effect of Atherogenic Index of Plasma on Pre-Percutaneous Coronary Intervention Thrombolysis in Myocardial Infarction Flow in Patients With ST Elevation Myocardial Infarction. Angiology. 2023; 75(9):841-848. DOI: 10.1177/00033197231185204. View

Eberly L, Neaton J, Thomas A, Yu D . Multiple-stage screening and mortality in the Multiple Risk Factor Intervention Trial. Clin Trials. 2005; 1(2):148-61. DOI: 10.1191/1740774504cn018oa. View

Liu J, Ma Y, Bu H, Qin W, Shi F, Zhang Y . Predictive Value of CHADS -VASc-HSF Score for Severity of Acute Coronary Syndrome. Clin Appl Thromb Hemost. 2022; 28:10760296211073969. PMC: 8796080. DOI: 10.1177/10760296211073969. View

Granger C, Goldberg R, Dabbous O, Pieper K, Eagle K, Cannon C . Predictors of hospital mortality in the global registry of acute coronary events. Arch Intern Med. 2003; 163(19):2345-53. DOI: 10.1001/archinte.163.19.2345. View

Modi R, Patted S, Halkati P, Porwal S, Ambar S, Mr P . CHADS-VASc-HSF score - New predictor of severity of coronary artery disease in 2976 patients. Int J Cardiol. 2016; 228:1002-1006. DOI: 10.1016/j.ijcard.2016.10.093. View

Collet J, Thiele H, Barbato E, Barthelemy O, Bauersachs J, Bhatt D . 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2020; 42(14):1289-1367. DOI: 10.1093/eurheartj/ehaa575. View

Lee C, van Domburg R, Hoye A, Lemos P, Tanabe K, Smits P . Predictors of survival after contemporary percutaneous coronary revascularization for acute myocardial infarction in the real world. J Invasive Cardiol. 2004; 16(11):627-31. View

10.

Kim K, Kim W, Hwang S, Kang W, Cho S, Kim W . The CHA2DS2VASc score can be used to stratify the prognosis of acute myocardial infarction patients irrespective of presence of atrial fibrillation. J Cardiol. 2014; 65(2):121-7. DOI: 10.1016/j.jjcc.2014.04.011. View

11.

Banerjee A . A review of family history of cardiovascular disease: risk factor and research tool. Int J Clin Pract. 2012; 66(6):536-43. DOI: 10.1111/j.1742-1241.2012.02908.x. View

12.

Daida H, Miyauchi K, Ogawa H, Yokoi H, Matsumoto M, Kitakaze M . Management and two-year long-term clinical outcome of acute coronary syndrome in Japan: prevention of atherothrombotic incidents following ischemic coronary attack (PACIFIC) registry. Circ J. 2013; 77(4):934-43. DOI: 10.1253/circj.cj-13-0174. View

13.

Sianos G, Morel M, Kappetein A, Morice M, Colombo A, Dawkins K . The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention. 2009; 1(2):219-27. View

14.

Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M . European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted.... Eur Heart J. 2012; 33(13):1635-701. DOI: 10.1093/eurheartj/ehs092. View

15.

Eagle K, Lim M, Dabbous O, Pieper K, Goldberg R, Van de Werf F . A validated prediction model for all forms of acute coronary syndrome: estimating the risk of 6-month postdischarge death in an international registry. JAMA. 2004; 291(22):2727-33. DOI: 10.1001/jama.291.22.2727. View

16.

Grundy S, Cleeman J, Merz C, Brewer Jr H, Clark L, Hunninghake D . Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation. 2004; 110(2):227-39. DOI: 10.1161/01.CIR.0000133317.49796.0E. View

17.

Hioki H, Miura T, Miyashita Y, Motoki H, Shimada K, Kobayashi M . Risk stratification using the CHADS-VASc score in patients with coronary heart disease undergoing percutaneous coronary intervention; sub-analysis of SHINANO registry. Int J Cardiol Heart Vasc. 2017; 7:76-81. PMC: 5497243. DOI: 10.1016/j.ijcha.2015.02.007. View

18.

Cetin M, Cakici M, Zencir C, Tasolar H, Baysal E, Balli M . Prediction of coronary artery disease severity using CHADS2 and CHA2DS2-VASc scores and a newly defined CHA2DS2-VASc-HS score. Am J Cardiol. 2014; 113(6):950-6. DOI: 10.1016/j.amjcard.2013.11.056. View

19.

Ford E, Giles W, Mokdad A . The distribution of 10-Year risk for coronary heart disease among US adults: findings from the National Health and Nutrition Examination Survey III. J Am Coll Cardiol. 2004; 43(10):1791-6. DOI: 10.1016/j.jacc.2003.11.061. View

20.

Chua S, Lo H, Chiu C, Shyu K . Use of CHADS₂ and CHA₂DS₂-VASc scores to predict subsequent myocardial infarction, stroke, and death in patients with acute coronary syndrome: data from Taiwan acute coronary syndrome full spectrum registry. PLoS One. 2014; 9(10):e111167. PMC: 4208805. DOI: 10.1371/journal.pone.0111167. View