Usefulness of the AHEAD score for prediction of all-cause death in patients with acute and chronic coronary syndromes

Shunsuke Tamaki; Akinori Higaki; Hiroshi Kawakami; Kazuhisa Nishimura; Katsuji Inoue; Shuntaro Ikeda; Osamu Yamaguchi; Naoyuki Akashi; Tetsuya Matoba; Takahide Kohro; Tomoyuki Kabutoya; Kazuomi Kario; Arihiro Kiyosue; Masaharu Nakayama; Yoshihiro Miyamoto; Kenichi Tsujita; Hideo Fujita; Ryozo Nagai

doi:10.1016/j.ijcrp.2025.200457

Usefulness of the AHEAD score for prediction of all-cause death in patients with acute and chronic coronary syndromes

Int J Cardiol Cardiovasc Risk Prev. 2025 Jun 20:26:200457. doi: 10.1016/j.ijcrp.2025.200457. eCollection 2025 Sep.

Authors

Shunsuke Tamaki¹, Akinori Higaki¹, Hiroshi Kawakami¹, Kazuhisa Nishimura¹, Katsuji Inoue¹, Shuntaro Ikeda¹, Osamu Yamaguchi¹, Naoyuki Akashi², Tetsuya Matoba³, Takahide Kohro⁴, Tomoyuki Kabutoya⁵, Kazuomi Kario⁵, Arihiro Kiyosue⁶, Masaharu Nakayama⁷, Yoshihiro Miyamoto⁸, Kenichi Tsujita⁹, Hideo Fujita², Ryozo Nagai¹⁰

Affiliations

¹ Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Japan.
² Division of Cardiovascular Medicine, Jichi Medical University Saitama Medical Center, Japan.
³ Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Japan.
⁴ Department of Clinical Informatics, Jichi Medical University School of Medicine, Japan.
⁵ Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Japan.
⁶ Department of Cardiovascular Medicine, University of Tokyo Hospital, Japan.
⁷ Department of Medical Informatics, Tohoku University Graduate School of Medicine, Japan.
⁸ Open Innovation Center, National Cerebral and Cardiovascular Center, Japan.
⁹ Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Japan.
¹⁰ Jichi Medical University School of Medicine, Japan.

Abstract

Background: The AHEAD (A: atrial fibrillation; H: hemoglobin; E: elderly; A: abnormal renal parameters; D: diabetes mellitus) score was developed to predict all-cause death (ACD) in patients with heart failure. However, its predictive value for ACD compared to the CHADS₂ score in patients with coronary artery disease (CAD) remains unknown.

Methods: This retrospective multicenter cohort study analyzed data of the patients who underwent percutaneous coronary intervention for acute (ACS) or chronic coronary syndromes (CCS) using the Clinical Deep Data Accumulation System (CLIDAS) database. The AHEAD score was calculated by assigning 1 point each for atrial fibrillation, anemia, age >70 years, elevated creatinine levels (>130 μmol/L), and diabetes mellitus.

Results: In total, 9033 patients were enrolled between April 2013 and March 2019. Cox multivariate analysis revealed that both the AHEAD and CHADS₂ scores were independently associated with ACD in patients with ACS and CCS (hazard ratio [HR], 1.91 [95 % CI, 1.70-2.14] for ACS and 1.72 [1.54-1.92] for CCS, and HR 1.17 [1.06-1.29] for ACS and 1.18 [1.08-1.29] for CCS, respectively). However, receiver operating characteristic curve analysis demonstrated that the AHEAD score had a significantly higher predictive value for ACD compared to the CHADS₂ score in both ACS and CCS. A significant difference was found in the rate of ACD among patients stratified by the AHEAD score in both groups.

Conclusions: The AHEAD score demonstrated superior predictive value for ACD compared to the CHADS₂ score in patients with CAD, regardless of whether they had ACS or CCS.

Keywords: All-cause death; Coronary artery disease; Prognosis; Risk score.