Dataset Information

Predictive Value of the CHA₂DS₂-VASc Score for Mortality in Hospitalized Acute Coronary Syndrome Patients With Chronic Kidney Disease.

ABSTRACT:

Background

Chronic kidney disease (CKD) patients have a high prevalence of coronary artery disease and a high risk of cardiovascular events. The present study assessed the value of the CHA₂DS₂-VASc score for predicting mortality among hospitalized acute coronary syndrome (ACS) patients with CKD.

Methods

This was a retrospective cohort study that included CKD patients who were hospitalized for ACS from January 2015 to May 2020. The CHA₂DS₂-VASc score for each eligible patient was determined. Patients were stratified into two groups according to CHA₂DS₂-VASc score: <6 (low) and ≥6 (high). The primary endpoint was all-cause mortality.

Results

A total of 313 eligible patients were included in the study, with a mean CHA₂DS₂-VASC score of 4.55 ± 1.68. A total of 220 and 93 patients were assigned to the low and high CHA₂DS₂-VASc score groups, respectively. The most common reason for hospitalization was unstable angina (39.3%), followed by non-ST-elevation myocardial infarction (35.8%) and ST-elevation myocardial infarction (24.9%). A total of 67.7% of the patients (212/313) received coronary reperfusion therapy during hospitalization. The median follow-up time was 23.0 months (interquartile range: 12-38 months). A total of 94 patients (30.0%) died during follow-up. The high score group had a higher mortality rate than the low score group (46.2 vs. 23.2%, respectively; p < 0.001). The cumulative incidence of all-cause death was higher in the high score group than in the low score group (Log-rank test, p < 0.001). Multivariate Cox regression analysis indicated that CHA₂DS₂-VASc scores were positively associated with all-cause mortality (hazard ratio: 2.02, 95% confidence interval: 1.26-3.27, p < 0.001).

Conclusion

The CHA₂DS₂-VASc score is an independent predictive factor for all-cause mortality in CKD patients who are hospitalized with ACS. This simple and practical scoring system may be useful for the early identification of patients with a high risk of death.

SUBMITTER: Wu Y

PROVIDER: S-EPMC8965867 | biostudies-literature | 2022

REPOSITORIES: biostudies-literature

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Publications

Predictive Value of the CHA<sub>2</sub>DS<sub>2</sub>-VASc Score for Mortality in Hospitalized Acute Coronary Syndrome Patients With Chronic Kidney Disease.

Wu Yaxin Y Gao Yanxiang Y Li Qing Q Wu Chao C Xie Enmin E Tu Yimin Y Guo Ziyu Z Ye Zixiang Z Li Peizhao P Li Yike Y Yu Xiaozhai X Ren Jingyi J Zheng Jingang J

Frontiers in cardiovascular medicine 20220316

<h4>Background</h4>Chronic kidney disease (CKD) patients have a high prevalence of coronary artery disease and a high risk of cardiovascular events. The present study assessed the value of the CHA<sub>2</sub>DS<sub>2</sub>-VASc score for predicting mortality among hospitalized acute coronary syndrome (ACS) patients with CKD.<h4>Methods</h4>This was a retrospective cohort study that included CKD patients who were hospitalized for ACS from January 2015 to May 2020. The CHA<sub>2</sub>DS<sub>2</sub ...[more]

PMID: 35369355

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Project description:BackgroundAcute ST-segment elevation myocardial infarction (STEMI) has a high morbidity and mortality rate. The congestive heart failure, hypertension, age, diabetes, previous stroke/transient ischemic attack (2 points) (CHADS2) and CHADS2 score with 2 points assigned for age >75 years-vascular disease (CHA2DS2-VASc) scores are widely used for risk stratification management of non-valvular atrial fibrillation stroke and have high prognostic value in cardiovascular disease. This study aims to investigate the predictive value of the emergency CHADS2 and CHA2DS2-VASc score on coronary artery lesions and prognosis in patients with acute STEMI.MethodsA total of 524 patients with STEMI from May 2018 to October 2021 were selected for emergency CHADS2 and CHA2DS2-VASc. Clinical data and laboratory indicators were collected. Patients were evaluated for coronary artery disease (CAD) and prognosis. Logistic regression and the receiver operating characteristic (ROC) curve were used to analyze the data.ResultsIn severe group, CysC levels, CHADS2, CHA2DS2-VASc score and the proportion of diabetes, stroke or transient ischemic attack (TIA), congestive heart failure, smoking history, Killip class ≥2 was higher than that in mild and moderate group. In poor prognosis group, levels of serum creatinine (Crea), CysC, hemoglobin (Hb), CHADS2, CHA2DS2-VASc score and the proportion of hypertension, diabetes, stroke or TIA, congestive heart failure, smoking history, and Killip class ≥2 was higher than that in good prognosis group. Diabetes (OR, 3.678; 95% CI: 2.876-5.872, 0.008), CHADS2 (OR, 3.829; 95% CI: 2.310-5.832, 0.003) and CHA2DS2-VASc score (OR, 4.671; 95% CI: 3.125-6.187, 0.000) were independent risk factors for the severity of CAD (P<0.05). Diabetes (OR, 3.287; 95% CI: 2.231-5.123, 0.012), Killip class ≥2 (OR, 2.212; 95% CI: 1.023-2.987, 0.045), LVEF (OR, 3.110; 95% CI: 2.124-5.031, 0.023), CHADS2 (OR, 3.228; 95% CI: 2.133-5.886, 0.005) and CHA2DS2-VASc score (OR, 3.988; 95% CI: 2.987-5.873, 0.001) were independent risk factors for prognosis of acute STEMI patients. Area under curve (AUC) value of CHA2DS2-VASc score in evaluating CAD and prognosis was 0.947, 0.931, higher than that of the CHADS2 score (0.836, 0.812) (P<0.05).ConclusionsMultiple factors jointly affect the severity and prognosis of CAD in patients with acute STEMI. The CHA2DS2-VASc score is better than the CHADS2 score in predicting the severity of coronary artery lesions and prognosis of patients, providing theoretical support for clinical practice.

Project description:Background and Purpose- Despite modest predictive ability for ischemic stroke (IS), the CHA2DS2-VASc score is widely used for stroke prediction in atrial fibrillation. Among patients with atrial fibrillation, we aimed to (1) compare the IS or transient ischemic attack (TIA) incidence by CHA2DS2-VASc in blacks and Hispanics versus whites; (2) compare predictive ability of CHA2DS2-VASc score for IS or TIA in blacks and Hispanics versus whites; and (3) determine improvement in predictive ability of CHA2DS2-VASc score from addition of race/ethnicity. Methods- Using data from Optum Clinformatics, a large administrative claims database, we analyzed patients with atrial fibrillation enrolled in commercial and Medicare Advantage health plans from 2009 to 2015. We computed IS or TIA incidence rates, improvement in C statistic, continuous and categorical net reclassification improvement, and relative integrated discrimination improvement from addition of race/ethnicity to CHA2DS2-VASc. Results- A total of 267 419 patients (mean age, 73.1 [SD, 12.3] years; 46.6% women; 84.2% white, 8.5% black, 7.3% Hispanic) were studied. After a mean follow-up of 22 months, there were 6202 IS or TIA events. IS or TIA incidence rates were higher in blacks than Hispanics or whites (1.65, 1.40, and 1.22 cases per 100 person-years, respectively) and increased with higher CHA2DS2-VASc, with no race/ethnicity-based differences (P for interaction=0.17). The CHA2DS2-VASc and CHA2DS2-VASc+race/ethnicity C statistic (95% CI) were 0.679 (0.670-0.686) and 0.679 (0.671-0.688). The CHA2DS2-VASc C statistic in the 3 groups were comparable. With addition of race/ethnicity, the categorical net reclassification improvement, continuous net reclassification improvement, and relative integrated discrimination improvement were -0.045 (95% CI, -0.067 to -0.025), 0.045 (95% CI, 0.025-0.068), and 0.016 (95% CI, 0.014-0.018). Conclusions- The predictive ability of CHA2DS2-VASc for IS or TIA in atrial fibrillation is comparable among whites, blacks, and Hispanics; hence, it can be used in the latter 2 groups. Addition of race/ethnicity to the CHA2DS2-VASc does not improve its predictive ability.

Dataset Information

Predictive Value of the CHA₂DS₂-VASc Score for Mortality in Hospitalized Acute Coronary Syndrome Patients With Chronic Kidney Disease.

Background

Methods

Results

Conclusion

Publications

Predictive Value of the CHA<sub>2</sub>DS<sub>2</sub>-VASc Score for Mortality in Hospitalized Acute Coronary Syndrome Patients With Chronic Kidney Disease.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

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Dataset Information

Predictive Value of the CHA2DS2-VASc Score for Mortality in Hospitalized Acute Coronary Syndrome Patients With Chronic Kidney Disease.

Background

Methods

Results

Conclusion

Publications

Predictive Value of the CHA<sub>2</sub>DS<sub>2</sub>-VASc Score for Mortality in Hospitalized Acute Coronary Syndrome Patients With Chronic Kidney Disease.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets

Predictive Value of the CHA₂DS₂-VASc Score for Mortality in Hospitalized Acute Coronary Syndrome Patients With Chronic Kidney Disease.