CHA2DS2-VASc and R2 CHA2DS2-VASc scores have predictive value in patients with acute coronary syndromes

INTRODUCTION The CHA(2)DS(2)-VASc and R(2)CHA(2)DS(2)-VASc scoring systems were designed to stratify thromboembolic risk in patients with atrial fibrillation. The R(2)CHA(2)DS(2)-VASc score, compared with the CHA(2)DS(2)-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, CHA(2)DS(2)-VASc, and R(2)CHA(2)DS(2)-VASc. RESULTS A total of 2557 patients were included in the final analysis with a median follow-up of about 5 years. The CHA(2)DS(2)-VASc and R(2)CHA(2)DS(2)-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 CHA(2)DS(2)-VASc; and HR, 1.41; 95% CI, 1.35-1.47; P < 0.0001 for R(2)CHA(2)DS(2)-VASc). At all time points (1, 3, and 5 years), the TIMI-STEMI score was a significantly better predictor than the CHA(2)DS(2)-VASc and R(2)CHA(2)DS(2)-VASc scores. The predictive value of the R(2)CHA(2)DS(2)-VASc score was comparable to that of the GRACE score at 3 and 5 years. CONCLUSIONS The CHA(2)DS(2)-VASc and R(2)CHA(2)DS(2)-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.