Chest
Original ResearchCardiovascular DiseaseRole of the CHADS2 Score in Acute Coronary Syndromes: Risk of Subsequent Death or Stroke in Patients With and Without Atrial Fibrillation
Section snippets
Materials and Methods
Consecutive patients with ACS were enrolled between September 15, 1995, and March 15, 2001, in a study assessing subsequent prognosis.13 The diagnosis of ACS was based on chest pain, other symptoms suggestive of myocardial ischemia, ECG changes, biochemical markers of myocardial necrosis, or previously recognized coronary artery disease. Patients aged > 80 years with a life expectancy < 1 year because of conditions other than coronary heart disease were not included. The study was approved by
Results
In this study, 2,335 patients (age 66 ± 10 years, 717 women) had confirmed ACS. Among them, 859 (37%) had ST segment elevation AMI (STEMI), 792 (34%) had non-ST segment elevation AMI (NSTEMI), and 684 (29%) had unstable angina. In total, 442 patients (age 71 ± 8 years, 142 women) had a type of AF, and 37% of these patients had STEMI, 41% had NSTEMI, and 21% had unstable angina. Among the 1,893 patients (age 64 ± 10 years, 575 women) without AF, 37% had STEMI, 32% had NSTEMI, and 31% had
Discussion
The CHADS2 score on admission was useful in predicting subsequent death and stroke in patients with ACS with and without AF, and scores > 2 were more predictive in patients without than with AF. The CHADS2 score, both unadjusted and when adjusted for potential confounders, correlated significantly with all-cause mortality. The score was also significantly associated with the rate of hospitalization for stroke. This association was strong in patients without AF, both unadjusted and after
Limitations
We cannot exclude the possibility that a study in a similar patient population at another site or at multiple sites might have other risk profiles and subsequent prognoses depending on differences in the care of ACS. Inclusion in the study took place between 1995 and 2001, and treatment strategies, especially for patients with STEMI, are different today, in our center and elsewhere. In patients with AF, the time course of events should be interpreted with caution because of the size of the
Conclusions
The CHADS2 score provided important information about risk and prognosis in patients with ACS, and AF was an important risk factor. In patients with an ACS, the CHADS2 score would identify patients with a higher risk of subsequent stroke and death, and an optimization of the therapy could result in a reduced risk of subsequent events.
Acknowledgments
Author contributions: Dr Poçi: contributed to the study concept and design, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, and final approval.
Dr Hartford: contributed to the study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, and final approval.
Mr Karlsson: contributed to the
References (27)
- et al.
Newly detected atrial fibrillation in patients with an implantable cardioverter-defibrillator is a strong risk marker of increased mortality
Heart Rhythm
(2009) - et al.
Impact of atrial fibrillation on the in-hospital and long-term survival of patients with acute myocardial infarction: a community-wide perspective
Am Heart J
(1990) - et al.
New atrial fibrillation after acute myocardial infarction independently predicts death: the GUSTO-III experience
Am Heart J
(2000) - et al.
Recent trends in the incidence rates of and death rates from atrial fibrillation complicating initial acute myocardial infarction: a community-wide perspective
Am Heart J
(2002) - et al.
Survival after stroke—the impact of CHADS2 score and atrial fibrillation
Int J Cardiol
(2010) - et al.
Treatment and short-term outcome in women and men with acute coronary syndromes
Int J Cardiol
(2005) - et al.
Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey on atrial fibrillation
Chest
(2010) - et al.
Development of a risk score for atrial fibrillation (Framingham Heart Study): a community-based cohort study
Lancet
(2009) - et al.
Impact of age on management and outcome of acute coronary syndrome: observations from the Global Registry of Acute Coronary Events (GRACE)
Am Heart J
(2005) - et al.
Atrial fibrillation in the setting of acute myocardial infarction: the GUSTO-I experience. Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries
J Am Coll Cardiol
(1997)
Impact of congestive heart failure and left ventricular systolic function on the prognostic significance of atrial fibrillation and atrial flutter following acute myocardial infarction
Int J Cardiol
Prediction of mortality after primary percutaneous coronary intervention for acute myocardial infarction: the CADILLAC risk score
J Am Coll Cardiol
GRACE, TIMI, Zwolle and CADILLAC risk scores—do they predict 5-year outcomes after ST-elevation myocardial infarction treated invasively?
Int J Cardiol
Cited by (116)
Use of the CHA<inf>2</inf>DS<inf>2</inf>-VASc score to predict subsequent myocardial infarction in atrial fibrillation
2023, Hellenic Journal of CardiologyPrognostic value of CHA2DS2-VASc score for the long-term cardiovascular events after coronary artery bypass grafting
2023, Turkish Journal of Thoracic and Cardiovascular SurgeryCHA2DS2-VASc and R2CHA2DS2-VASc scores predict mortality in high cardiovascular risk population
2022, European Journal of Clinical Investigation
Parts of this article have been presented at different scientific meetings during 2010: (Heart Rhythm 2010, Denver, Colorado, May 14, 2010, poster; Cardisotim 2010, Nice, France, June 18, 2010, oral presentation; and ESC Congress 2010, Stockholm, Sweden, August 29, 2010, poster).
Funding/Support: This study was supported by the Swedish Research Council (14231), the Swedish Heart and Lung Foundation, the Vardal Foundation, Gothenburg University, and the Göteborg Medical Society.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.