CHA2DS2-VASc and R2CHA2DS2-VASc scores have predictive value in patients with acute coronary syndromes

INTRODUCTION The CHA2DS2 -VASc and R2CHA2DS2-VASc scoring systems were designed to stratify thromboembolic risk in patients with atrial fibrillation. The R2CHA2DS2-VASc score, compared with the CHA2DS2-VASc, was modified by adding reduced creatinine clearance. 

OBJECTIVES The aim of the study was to assess the long-term predictive value of these scores in patients with acute coronary syndrome (ACS) and to compare their utility with TIMI and GRACE scores in this patient group. 

PATIENTS AND METHODS We performed a pooled analysis of 5 independent populations with ACS with a long-term follow-up available. The primary endpoint was defined as all-cause mortality. The following risk scores were calculated: TIMI-STEMI or TIMI-NSTEMI, GRACE, CHA2 DS2 -VASc, and R2CHA2DS2-VASc.

RESULTS A total of 2557 patients were included in the final analysis with a median follow-up of about 5 years. The CHA2DS2-VASc and R2CHA2DS2-VASc scores were significant predictors of total mortality in the pooled analysis. After correction for heart rate and systolic blood pressure on admission as well as previous myocardial infarction, the scores were still significantly predictive of mortality (hazard ratio [HR], 1.47; 95% confidence interval [CI], 1.39–1.54; P <0.0001 for CHA2DS2-VASc; and HR, 1.41; 95% CI, 1.35–1.47; P <0.0001 for R2CHA2DS2-VASc). At all time points (1, 3, and 5 years), the TIMI-STEMI score was a significantly better predictor than the CHA2DS2-VASc and R2CHA2DS2-VASc scores. The predictive value of the R2CHA2DS2-VASc score was comparable to that of the GRACE score at 3 and 5 years. 

CONCLUSIONS The CHA2DS2-VASc and R2CHA2DS2-VASc scores are significant predictors of all-cause mortality in a long-term follow-up in patients with ACS. These simple risk scores may be easily applied in clinical practice in this patient group.<