Predictive value of CHADS2 score for cardiovascular events in patients with acute coronary syndrome and documented coronary artery disease

Background/Aims: The CHADS(2) score, used to predict the risk of ischemic stroke in atrial fibrillation (AF) patients, has been reported recently to predict ischemic stroke in patients with coronary heart disease, regardless of the presence of AF. However, little data are available regarding the relationship between the CHADS(2) score and cardiovascular outcomes. Methods: This was a retrospective study on 104 patients admitted for acute coronary syndrome (ACS) who underwent coronary angiography, carotid ultrasound, and transthoracic echocardiography. Results: The mean age of the subjects was 60.1 +/- 12.6 years. The CHADS(2) score was as follows: 0 in 46 patients (44.2%), 1 in 31 (29.8%), 2 in 18 (17.3%), and >= 3 in 9 patients (8.7%). The left atrial volume index (LAVi) showed a positive correlation with the CHADS(2) score (20.8 +/- 5.9 for 0; 23.2 +/- 6.7 for 1; 26.6 +/- 10.8 for 2; and 30.3 +/- 8.3 mL/m(2) for >= 3; p = 0.001). The average carotid total plaque area was significantly increased with CHADS(2) scores >= 2 (4.97 +/- 7.17 mm(2) vs. 15.52 +/- 14.61 mm(2); p = 0.002). Eight patients experienced cardiovascular or cerebrovascular (CCV) events during a mean evaluation period of 662 days. A CHADS(2) score >= 3 was related to an increase in the risk of CCV events (hazard ratio, 14.31; 95% confidence interval, 3.53 to 58.06). Furthermore, LAVi and the severity of coronary artery obstructive disease were also associated with an increased risk of CCV events. Conclusions: The CHADS(2) score may be a useful prognostic tool for predicting CCV events in ACS patients with documented coronary artery disease.