Risk stratification using the CHA 2DS 2-VASc score in patients with coronary heart disease undergoing percutaneous coronary intervention; sub-analysis of SHINANO registry

摘要

Background CHADS 2 or CHA 2 DS 2 -VASc score is used for prediction of stroke in patients with atrial fibrillation (AF). Recently, CHADS 2 score is reported to have prognostic value in acute coronary syndrome without AF. However, clinical validation of CHA 2 DS 2 -VASc score for prognostic stratification in coronary heart disease (CHD) without AF remains uncertain. In this study, we evaluate whether CHA 2 DS 2 -VASc score could predict clinical outcome in CHD without known AF. Methods SHINANO registry was a prospective, observational, multicenter cohort study, enrolling 1923 consecutive patients with CHD from August 2012 to July 2013. Two hundred nine patients were excluded because of known AF. We calculated CHA 2 DS 2 -VASc score in the remaining 1714 patients (mean age 70±11years, 23% female) without known AF. To assess the clinical validation of CHA 2 DS 2 -VASc score, we divided patients into 3 groups according to the tertiles (score 0–2, 3–4, and ≥5). The primary endpoint was MACE including death, nonfatal myocardial infarction, and ischemic stroke at 1year. Results One-year follow-up was completed in 1632 patients (95.2%). Cumulative incidence of MACE was 139 cases. In Kaplan–Meier analysis, incidence of MACE was significantly higher in patients with CHA 2 DS 2 -VASc score ≥5 compared to 3–4 and 0–2 (14.6% vs. 6.8% vs. 5.3%, p <0.001). In multivariate Cox-regression analysis, CHA 2 DS 2 -VASc score was an independent predictor for MACE (hazard ratio 1.26, 95% confidence interval 1.15–1.39 p <0.001). Conclusions This study demonstrated that CHA 2 DS 2 -VASc score could provide prognostic information in CHD without known AF.