Use of the CHA2DS2-VASc score to predict subsequent myocardial infarction in atrial fibrillation

Su-Kiat Chua; Pang-Shuo Huang; Jien-Jiun Chen; Fu-Chun Chiu; Juey-Jen Hwang; Chia-Ti Tsai

doi:10.1016/j.hjc.2023.08.010

Use of the CHA₂DS₂-VASc score to predict subsequent myocardial infarction in atrial fibrillation

Hellenic J Cardiol. 2023 Aug 25:S1109-9666(23)00147-1. doi: 10.1016/j.hjc.2023.08.010. Online ahead of print.

Authors

Su-Kiat Chua¹, Pang-Shuo Huang², Jien-Jiun Chen², Fu-Chun Chiu², Juey-Jen Hwang³, Chia-Ti Tsai⁴

Affiliations

¹ School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan, ROC; Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, ROC.
² Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Taiwan, ROC.
³ Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, 100, Taiwan, ROC; Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan, ROC.
⁴ Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, 100, Taiwan, ROC; Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan, ROC. Electronic address: Cttsai1999@gmail.com.

PMID: 37633490
DOI: 10.1016/j.hjc.2023.08.010

Abstract

Background: The risk of subsequent myocardial infarction (MI) varies widely in patients with atrial fibrillation (AF). No convenient scoring system currently exists to identify MI in AF. While each element of the CHA2DS2-VASc (congestive heart failure; hypertension; age ≥75 years [doubled]; type 2 diabetes; previous stroke or thromboembolism [doubled]; vascular disease; age 65-75 years; and sex category) score can increase the likelihood of MI, this retrospective longitudinal study aimed to determine the accuracy of the CHA2DS2-VASc score in predicting subsequent MI risk in AF.

Methods: A total of 29,341 patients with AF were enrolled and followed up from January 2010 until the first occurrence of MI or until December 2020. The primary endpoint was the occurrence of subsequent MI.

Results: The average age of the study population was 71 years, and 43.2% were male. The mean CHA2DS2-VASc score was found to be higher in patients with AF who had experienced an MI than in those who had not (3.56 ± 1.92 vs. 3.32 ± 1.81, p < 0.001). During the long-term follow-up, the risk of subsequent MI increased by 22% with every one-point increase in the CHA2DS2-VASc score (hazard ratio 1.22, 95% confidence interval 1.19-1.25; p < 0.001). Kaplan-Meier analysis revealed that high CHA2DS2-VASc scores were more likely to experience an MI than those with low CHA2DS2-VASc scores (log-rank p < 0.001). Furthermore, the CHA2DS2-VASc score was a significant predictor of MI in multivariate regression analysis.

Conclusion: The CHA₂DS₂-VASc score is a valuable predictor of subsequent MI risk in patients with AF.

Keywords: Atrial fibrillation; CHA(2)DS(2)-VASc score; Myocardial infarction.