Study on the predictive ability of emergency CHADS2 score and CHA2DS2-VASc score for coronary artery disease and prognosis in patients with acute ST-segment elevation myocardial infarction

Xin Huang; Hong Lv; Zeyan Liu; Yuan Liu; Xue Yang

doi:10.21037/jtd-22-763

Study on the predictive ability of emergency CHADS₂ score and CHA₂DS₂-VASc score for coronary artery disease and prognosis in patients with acute ST-segment elevation myocardial infarction

J Thorac Dis. 2022 Jul;14(7):2611-2620. doi: 10.21037/jtd-22-763.

Authors

Xin Huang^#¹, Hong Lv^#², Zeyan Liu^#³, Yuan Liu⁴, Xue Yang⁵

Affiliations

¹ Department of Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China.
² Department of Cardiology, The Third People's Hospital of Xinjiang Autonomous Region, Urumqi, China.
³ Emergency Internal Medicine Department, The Second Hospital of Anhui Medical University, Hefei, China.
⁴ Department of Emergency, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China.
⁵ Department of Outpatient, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China.

^# Contributed equally.

Abstract

Background: Acute ST-segment elevation myocardial infarction (STEMI) has a high morbidity and mortality rate. The congestive heart failure, hypertension, age, diabetes, previous stroke/transient ischemic attack (2 points) (CHADS₂) and CHADS₂ score with 2 points assigned for age >75 years-vascular disease (CHA₂DS₂-VASc) scores are widely used for risk stratification management of non-valvular atrial fibrillation stroke and have high prognostic value in cardiovascular disease. This study aims to investigate the predictive value of the emergency CHADS₂ and CHA₂DS₂-VASc score on coronary artery lesions and prognosis in patients with acute STEMI.

Methods: A total of 524 patients with STEMI from May 2018 to October 2021 were selected for emergency CHADS₂ and CHA₂DS₂-VASc. Clinical data and laboratory indicators were collected. Patients were evaluated for coronary artery disease (CAD) and prognosis. Logistic regression and the receiver operating characteristic (ROC) curve were used to analyze the data.

Results: In severe group, CysC levels, CHADS₂, CHA₂DS₂-VASc score and the proportion of diabetes, stroke or transient ischemic attack (TIA), congestive heart failure, smoking history, Killip class ≥2 was higher than that in mild and moderate group. In poor prognosis group, levels of serum creatinine (Crea), CysC, hemoglobin (Hb), CHADS₂, CHA₂DS₂-VASc score and the proportion of hypertension, diabetes, stroke or TIA, congestive heart failure, smoking history, and Killip class ≥2 was higher than that in good prognosis group. Diabetes (OR, 3.678; 95% CI: 2.876-5.872, 0.008), CHADS₂ (OR, 3.829; 95% CI: 2.310-5.832, 0.003) and CHA₂DS₂-VASc score (OR, 4.671; 95% CI: 3.125-6.187, 0.000) were independent risk factors for the severity of CAD (P<0.05). Diabetes (OR, 3.287; 95% CI: 2.231-5.123, 0.012), Killip class ≥2 (OR, 2.212; 95% CI: 1.023-2.987, 0.045), LVEF (OR, 3.110; 95% CI: 2.124-5.031, 0.023), CHADS₂ (OR, 3.228; 95% CI: 2.133-5.886, 0.005) and CHA₂DS₂-VASc score (OR, 3.988; 95% CI: 2.987-5.873, 0.001) were independent risk factors for prognosis of acute STEMI patients. Area under curve (AUC) value of CHA₂DS₂-VASc score in evaluating CAD and prognosis was 0.947, 0.931, higher than that of the CHADS₂ score (0.836, 0.812) (P<0.05).

Conclusions: Multiple factors jointly affect the severity and prognosis of CAD in patients with acute STEMI. The CHA₂DS₂-VASc score is better than the CHADS₂ score in predicting the severity of coronary artery lesions and prognosis of patients, providing theoretical support for clinical practice.

Keywords: CHADS2 score with 2 points assigned for age >75 years-vascular disease score (CHA2DS2-VASc score); Congestive heart failure, hypertension, age, diabetes, previous stroke/transient ischemic attack (2 points) score (CHADS2 score); acute ST-segment elevation myocardial infarction (acute STEMI); coronary artery lesions.