1
|
Teodorovich N, Gandelman G, Jonas M, Fabrikant Y, Swissa MS, Shimoni S, George J, Swissa M. The CHA 2DS 2-VAS C Score Predicts Mortality in Patients Undergoing Coronary Angiography. Life (Basel) 2023; 13:2026. [PMID: 37895408 PMCID: PMC10608546 DOI: 10.3390/life13102026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/24/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The CHA2DS2-VASC score is used to predict the risk of thromboembolic complications in patients with atrial fibrillation (AF). We hypothesized that the CHA2DS2-VASC score can be used to predict mortality in patients undergoing coronary angiography. METHODS AND RESULTS This was a prospective study of 990 patients undergoing coronary angiography. The median follow-up was 2294 days. The patients were categorized into two groups according to their CHA2DS2-VASC score: group I had scores <4 and group II had scores ≥4 (527 (53.2%) and 463 (46.8%), respectively). A Kaplan-Meier analysis demonstrated a significant association between the CHA2DS2-VASC score and mortality (69/527 (13.1%) vs. 179/463 (38.7%) for group I vs. group II, respectively, p < 0.0001). The association remained significant in patients with and without AF, reduced and preserved LVEF, normal and reduced kidney function, and with and without ACS (p < 0.009 to p < 0.0001 for all). In the Cox regression model, which combined the CHA2DS2-VASC score, the presence of AF, LVEF, anemia, and renal insufficiency, an elevated CHA2DS2-VASC score of ≥4 was independently associated with higher mortality (HR 2.12, CI 1.29-3.25, p = 0.001). CONCLUSIONS The CHA2DS2VASC score is a simple and reliable mortality predictor in patients undergoing coronary angiography and should be used for the initial screening for such patients.
Collapse
Affiliation(s)
- Nicholay Teodorovich
- Kaplan Medical Center, Rehovot and the Hebrew University, Jerusalem 7661041, Israel; (G.G.); (M.J.); (Y.F.); (S.S.); (J.G.); (M.S.)
| | - Gera Gandelman
- Kaplan Medical Center, Rehovot and the Hebrew University, Jerusalem 7661041, Israel; (G.G.); (M.J.); (Y.F.); (S.S.); (J.G.); (M.S.)
| | - Michael Jonas
- Kaplan Medical Center, Rehovot and the Hebrew University, Jerusalem 7661041, Israel; (G.G.); (M.J.); (Y.F.); (S.S.); (J.G.); (M.S.)
| | - Yakov Fabrikant
- Kaplan Medical Center, Rehovot and the Hebrew University, Jerusalem 7661041, Israel; (G.G.); (M.J.); (Y.F.); (S.S.); (J.G.); (M.S.)
| | - Michael Sraia Swissa
- Shari-Zedek Medical Center, and the Hebrew University, Jerusalem 9103102, Israel;
| | - Sara Shimoni
- Kaplan Medical Center, Rehovot and the Hebrew University, Jerusalem 7661041, Israel; (G.G.); (M.J.); (Y.F.); (S.S.); (J.G.); (M.S.)
| | - Jacob George
- Kaplan Medical Center, Rehovot and the Hebrew University, Jerusalem 7661041, Israel; (G.G.); (M.J.); (Y.F.); (S.S.); (J.G.); (M.S.)
| | - Moshe Swissa
- Kaplan Medical Center, Rehovot and the Hebrew University, Jerusalem 7661041, Israel; (G.G.); (M.J.); (Y.F.); (S.S.); (J.G.); (M.S.)
| |
Collapse
|
2
|
Artac I, Karakayali M, Omar T, Hamideyin S, Karabag Y, Ilis D, Rencuzogullari I. Value of ATRIA stroke risk score in predicting atrial high-rate episodes: A comparison of six different risk scores. Pacing Clin Electrophysiol 2023; 46:978-985. [PMID: 37283495 DOI: 10.1111/pace.14749] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/15/2023] [Accepted: 05/26/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Atrial high-rate episodes (AHRE) are asymptomatic atrial tachy-arrhythmias detected through continuous monitoring with a cardiac implantable electronic device (CIED). AHRE's have been associated with increased risks of developing clinically manifested atrial fibrillation (AF), thromboembolism, cardiovascular events, and mortality. Several variables has been researched and identified to predict AHRE development. The aim of this study, which compared the six frequently-used scoring systems for thromboembolic risk in AF (CHA2 DS2 -VASc, mC2 HEST, HAT2 CH2 , R2 -CHADS2 , R2 -CHA2 DS2 -VASc, and ATRIA) in terms of their prognostic power in predicting AHRE. MATERIALS AND METHODS This retrospective study included 174 patients with CIED's. The study population was divided into two groups according to presence of AHRE: patients with AHRE (+) and patients without AHRE (-). Thereafter, patients baseline characteristics and scoring systems were analyzed for prediction of AHRE. RESULTS The distribution of patients' baseline characteristics and scoring systems according to presence of AHRE was evaluated. Furthermore, ROC curve analyses of the stroke risk scoring systems have been investigated in terms of predicting the development of AHREs. ATRIA, which predicted AHRE with a specificity of 92% and sensitivity of 37.5% for ATRIA values of >6, performed better than other scoring systems in predicting AHRE (AUC: 0.700, 0.626-0.767 95% confidence interval (CI), p = .004) CONCLUSION: AHRE is common in patients with a CIED. In this context, several risk scoring systems have been used to predict the development of AHRE in patients with a CIED. This study's findings revealed that The ATRIA stroke risk scoring system performed better than other commonly used risk scoring systems in predicting AHRE.
Collapse
Affiliation(s)
- Inanc Artac
- Department of Cardiology, Kafkas University Faculty of Medicine, Kars, Turkey
| | - Muammer Karakayali
- Department of Cardiology, Kafkas University Faculty of Medicine, Kars, Turkey
| | - Timor Omar
- Department of Cardiology, Kafkas University Faculty of Medicine, Kars, Turkey
| | - Serif Hamideyin
- Department of Cardiology, Kafkas University Faculty of Medicine, Kars, Turkey
| | - Yavuz Karabag
- Department of Cardiology, Kafkas University Faculty of Medicine, Kars, Turkey
| | - Dogan Ilis
- Department of Cardiology, Kars Harakani State Hospital, Kars, Turkey
| | | |
Collapse
|
3
|
D'Errico MM, Piscitelli P, Mirijello A, Santoliquido M, Salvatori M, Vigna C, Vendemiale G, Lamacchia O, Fontana A, Copetti M, Pontremoli R, De Cosmo SA. CHA2DS2-VASc and R2CHA2DS2-VASc scores predict mortality in high cardiovascular risk population. Eur J Clin Invest 2022; 52:e13830. [PMID: 35778894 DOI: 10.1111/eci.13830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/30/2022] [Accepted: 06/30/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The CHA2 DS2 -VASc score, widely used to estimate cardioembolic risk in patients with atrial fibrillation (AF), appears to be useful also in predicting vascular adverse events and death in different sets of patients without AF. The R2 CHA2 DS2 -VASc score, which includes renal impairment, allows a better prediction of death and thromboembolism in patients without AF. The aims of our study were to assess, in a large sample of patients at high cardiovascular (CV) risk, (i) the correlation between CHA2 DS2 -VASc and R2 CHA2 DS2 -VASc with all-cause mortality, and (ii) to compare the performances of CHA2 DS2 -VASc and R2 CHA2 DS2 -VASc in predicting all-cause mortality. METHODS In this single-centre prospective observational study, conducted at the Research Hospital 'Casa Sollievo della Sofferenza' between June 2016 and December 2018, 1017 CV patients at high risk of undergoing coronary angiography were enrolled. RESULTS CHA₂DS₂-VASc and R2 CHA2 DS2 -VASc scores significantly associated with all-cause mortality. For each one-point increase in CHA2 DS2 -VASc or R2 CHA2 DS2 -VASc scores, mortality increased by almost 1.5-fold. The R2 CHA2 DS2 -VASc score (C-statistic = 0.71; 95% CI = 0.65-76) outperformed the CHA2 DS2 -VASc score (C-statistic = 0.66; 95% CI = 0.61-0.71) in predicting 4-year mortality (delta C-statistic = 0.05; 95% CI = 0.02-0.07). The better predictive ability of the R-CHA2 DS2 -VASc score was also demonstrated by an IDI = 0.027 (95% CI = 0.021-0.034, p < .00001) and a relative IDI = 62.8% (95% CI = 47.9%-81.3%, p < .00001). The R2 CHA2 DS2 -VASc score correctly reclassified the patients with a NRI = 0.715 (95% = 0.544-0.940, p < .00001). CONCLUSIONS The CHA₂DS₂-VASc and R2 CHA2 DS2 -VASc scores are useful predictors of all-cause mortality in subjects at high CV risk, with the R2 CHA2 DS2 -VASc score being the best performer.
Collapse
Affiliation(s)
- Maria Maddalena D'Errico
- Unit of Internal Medicine, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Pamela Piscitelli
- Unit of Internal Medicine, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Antonio Mirijello
- Unit of Internal Medicine, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Mariateresa Santoliquido
- Unit of Internal Medicine, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.,Geriatrics Residency School, University of Foggia, Foggia, Italy
| | - Mauro Salvatori
- Unit of Cardiology, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Carlo Vigna
- Unit of Cardiology, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | | | - Olga Lamacchia
- Unit of Endocrinology, University of Foggia, Foggia, Italy
| | - Andrea Fontana
- Biostatistics Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Massimiliano Copetti
- Biostatistics Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Roberto Pontremoli
- University of Genoa and IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Salvatore A De Cosmo
- Unit of Internal Medicine, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| |
Collapse
|
4
|
Castini DC, Persampieri S, Sabatelli L, Valli F, Ferrante G, Zambelli D, Toriello F, Provenzale G, Gentile D, Bursi F, Centola M, Carugo S. Incremental Value of Renal Dysfunction Addition to the CHA2DS2-Vasc Score for Mortality Prediction in Patients with Acute Coronary Syndrome. Cardiology 2021; 146:538-546. [PMID: 33965936 DOI: 10.1159/000515986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 03/12/2021] [Indexed: 01/10/2023]
Abstract
INTRODUCTION This study analyzes the usefulness of the CHA2DS2-VASc score for mortality prediction in patients with acute coronary syndromes (ACSs) and evaluates if the addition of renal functional status could improve its predictive accuracy. METHODS CHA2DS2-VASc score was calculated by using both the original scoring system and adding renal functional status using 3 alternative renal dysfunction definitions (CHA2DS2-VASc-R1: eGFR <60 mL/min/1.73 mq = 1 point; CHA2DS2-VASc-R2: eGFR <60 mL/min/1.73 mq = 2 points; and CHA2DS2-VASc-R3: eGFR <60 mL/min/1.73 mq = 1 point, <30 mL/min/1.73 mq = 2 points). Inhospital mortality (IHM) and post-discharge mortality (PDM) were recorded, and discrimination of the various risk models was evaluated. Finally, the net reclassification index (NRI) was calculated to compare the mortality risk classification of the modified risk models with that of the original score. RESULTS Nine hundred and eight ACS patients (median age 68 years, 30% female, 51% ST-elevation) composed the study population. Of the 871 patients discharged, 865 (99%) completed a 12-month follow-up. The IHM rate was 4.1%. The CHA2DS2-VASc score demonstrated a good discriminative performance for IHM (C-statistic 0.75). Although all the eGFR-modified risk models showed higher C-statistics than the original model, a statistically significant difference was observed only for CHA2DS2-VASc-R3. The PDM rate was 4.5%. The CHA2DS2-VASc C-statistic for PDM was 0.75, and all the modified risk models showed significantly higher C-statistics values than the original model. The NRI analysis showed similar results. CONCLUSIONS CHA2DS2-VASc score demonstrated a good predictive accuracy for IHM and PDM in ACS patients. The addition of renal dysfunction to the original score has the potential to improve identification of patients at the risk of death.
Collapse
Affiliation(s)
- Diego Carlo Castini
- Division of Cardiology, Heart and Lung Department, San Paolo Hospital, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Simone Persampieri
- Division of Cardiology, Heart and Lung Department, San Paolo Hospital, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Ludovico Sabatelli
- Division of Cardiology, Heart and Lung Department, San Paolo Hospital, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Federica Valli
- Division of Cardiology, Heart and Lung Department, San Paolo Hospital, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Giulia Ferrante
- Division of Cardiology, Heart and Lung Department, San Paolo Hospital, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Daniel Zambelli
- Division of Cardiology, Heart and Lung Department, San Paolo Hospital, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Filippo Toriello
- Department of Clinical Sciences and Community Health, University of Milan, IRCCS Cà Granda Ospedale Maggiore Policlinico Foundation, Internal Medicine Department, Cardiology Unit, Milan, Italy
| | - Giovanni Provenzale
- Department of Clinical Sciences and Community Health, University of Milan, IRCCS Cà Granda Ospedale Maggiore Policlinico Foundation, Internal Medicine Department, Cardiology Unit, Milan, Italy
| | - Domitilla Gentile
- Department of Clinical Sciences and Community Health, University of Milan, IRCCS Cà Granda Ospedale Maggiore Policlinico Foundation, Internal Medicine Department, Cardiology Unit, Milan, Italy
| | - Francesca Bursi
- Division of Cardiology, Heart and Lung Department, San Paolo Hospital, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Marco Centola
- Division of Cardiology, Heart and Lung Department, San Paolo Hospital, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Stefano Carugo
- Department of Clinical Sciences and Community Health, University of Milan, IRCCS Cà Granda Ospedale Maggiore Policlinico Foundation, Internal Medicine Department, Cardiology Unit, Milan, Italy
| |
Collapse
|
5
|
Boyanpally A, Cutting S, Furie K. Acute Ischemic Stroke Associated with Myocardial Infarction: Challenges and Management. Semin Neurol 2021; 41:331-339. [PMID: 33851390 DOI: 10.1055/s-0041-1726333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Acute ischemic stroke (AIS) and acute myocardial infarction (AMI) may co-occur simultaneously or in close temporal succession, with occurrence of one ischemic vascular event increasing a patient's risk for the other. Both employ time-sensitive treatments, and both benefit from expert consultation. Patients are at increased risk of stroke for up to 3 months following AMI, and aggressive treatment of AMI, including use of reperfusion therapy, decreases the risk of AIS. For patients presenting with AIS in the setting of a recent MI, treatment with alteplase, an intravenous tissue plasminogen activator, can be given, provided anterior wall myocardial involvement has been carefully evaluated. It is important for clinicians to recognize that troponin elevations can occur in the setting of AIS as well as other clinical scenarios and that this may have implications for short- and long-term mortality.
Collapse
Affiliation(s)
- Anusha Boyanpally
- Department of Neurology, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island
| | - Shawna Cutting
- Department of Neurology, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island.,The Norman Prince Neuroscience Institute, Rhode Island Hospital, Providence, Rhode Island
| | - Karen Furie
- Department of Neurology, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island.,The Norman Prince Neuroscience Institute, Rhode Island Hospital, Providence, Rhode Island
| |
Collapse
|
6
|
Liu L, Liu Z, Chen X, He S. Thromboembolism in Patients with Hypertrophic Cardiomyopathy. Int J Med Sci 2021; 18:727-735. [PMID: 33437207 PMCID: PMC7797548 DOI: 10.7150/ijms.50167] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 11/18/2020] [Indexed: 02/05/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is an inherited cardiac disease, which has a marked heterogeneity in clinical expression, natural history, and prognosis. HCM is associated with a high prevalence of thromboembolic events (stroke and systemic embolic events), even if taking no account of atrial fibrillation (AF), leading to unexpected disability and death in patients of all ages. Several risk factors of thromboembolism such as AF, greater age, left atrial diameter, heart failure and others have been confirmed in patients with HCM. Conventional thromboembolic predictive models were estimated by several trials in HCM population but it turned out to be unsatisfactory. Based on those previous explorations, researchers tried to modify or develop novel models suitable for HCM population in thromboembolism prediction. In consideration of catastrophic advent events of thromboembolism, current guidelines have recommended life-long anticoagulant therapy after a single short AF. Therefore, early identification of risk factors for thromboembolism, accurate risk stratification, timely preventive measures and aggressive management may help to avoid serious adverse thromboembolic events in HCM population.
Collapse
Affiliation(s)
- Lu Liu
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Zheng Liu
- Nursing Department, West China School of Nursing, West China Hospital of Sichuan University, Chengdu, China
| | - Xiaoping Chen
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Sen He
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| |
Collapse
|
7
|
Zhang J, Potpara T, Lip GYH. Stroke risk stratification in hypertrophic cardiomyopathy. Hellenic J Cardiol 2020; 61:318-320. [DOI: 10.1016/j.hjc.2020.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
|
8
|
Yang Y, Yan K, Li Y, Yao Q, Jiang M, Zhu C. [Value of CHA 2DS 2-VASc score in predicting stroke recurrence in first-ever ischemic stroke survivors without atrial fibrillation]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2020; 40:786-792. [PMID: 32895193 DOI: 10.12122/j.issn.1673-4254.2020.06.03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To test the performance of CHA2DS2-VASc score in predicting stroke recurrence in first-ever ischemic stroke survivors without atrial fibrillation (AF). METHODS A total of 768 patients were included in this study, including 475 male (61.85%) and 293 female patients (38.15%) with a mean age of 61.52±12.59 years (17-90 years). The baseline information of the patients was collected by face-to-face questionnaire survey and electronic medical record review, and their follow-up information was collected by telephone follow-up once every 3 months. Chi-square test and Wilcoxon rank sum test were used to compare the baseline characteristics between the patients regularly followed up and those withdrawn from the study. The area under the ROC curve (AUC), sensitivity, specificity, positive likelihood ratio and other indicators of CHA2DS2-VASc score were determined, and C-index based on Cox proportional hazards model was used to evaluate the performance of CHA2DS2- VASc score in predicting the risk of stroke recurrence in patients at different time points during the follow-up. RESULTS The 1-year, 3-year, and 5-year recurrence rate of stroke was 10.59%, 20.45%, and 29.46% in these patients, respectively. The AUC value, Optimal Operating Point (OOP) and the corresponding positive likelihood ratios (LR+) for predicting stroke recurrence were 0.558 (95%CI: 0.492-0.624), 4.5, and 1.256 at 1 year; 0.574 (95%CI: 0.517-0.630), 4.5, and 1.397 at 3 years; and 0.604 (95%CI: 0.548-0.661), 4.5, and 1.655 at 5 years, respectively. Sensitivity analysis of congestive heart failure showed that the predictive effect of CHA2DS2-VASc score was basically unchanged. CONCLUSIONS CHA2DS2-VASc score can be used to predict the 3-year and 5-year risk of stroke recurrence in first-ever ischemic stroke survivors without AF. The score has a better prediction ability for long-term stroke recurrence, but the prediction value remains low, suggesting the need to further improve the score or establish a new score for predicting stroke recurrence.
Collapse
Affiliation(s)
- Yanling Yang
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Ke Yan
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Yawen Li
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Qiang Yao
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Min Jiang
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Cairong Zhu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| |
Collapse
|
9
|
Wang Z, Liao H, He S, Chen X. Performance and validation of R-CHA 2DS 2VASc score for thromboembolism in patients with hypertrophic cardiomyopathy. Hellenic J Cardiol 2019; 61:313-317. [PMID: 31472238 DOI: 10.1016/j.hjc.2019.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 07/01/2019] [Accepted: 08/21/2019] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To validate the modified R-CHA2DS2VASc score as a predictor of thromboembolism in HCM patients. METHODS A total of 446 HCM patients were enrolled in our study, thirty-one (6.95%) patients experienced thromboembolic events during the follow-up time of 1786.7 person-years. The association between R-CHA2DS2VASc score and risk of thromboembolism was assessed by Cox's proportional hazard analysis. The discriminatory power of R-CHA2DS2VASc score for thromboembolism prediction was assessed by Harrell's C-statistic and validated internally by bootstrapping methods. Calibration plot was plotted by observed versus expected probabilities of thromboembolism. RESULTS The R-CHA2DS2VASc score was well calibrated with 0.84 thromboembolic events per 100 person-years in the predefined low risk (R-CHA2DS2VASc score ≤2) group, 1.84 in the low to moderate risk (R-CHA2DS2VASc score 3-4) group, 4.67 in the moderate to high risk (R-CHA2DS2VASc score 5-7) group, and 17.54 in the high risk (R-CHA2DS2VASc score ≥8) group. Hazard ratios for thromboembolism were 2.88 (95%CI: 1.06-7.82, P=0.038) for low to moderate versus low risk group, 5.30 (95%CI: 2.14-13.12, P=0.0003) for moderate to high versus low risk group, and 16.57 5.30 (95%CI: 4.96-55.33, P<0.0001) for high versus low risk group after adjusting left atria size. The Harrell's C statistic was 0.7737 (95% CI: 0.65-0.89) for R-CHA2DS2VASc score. CONCLUSION The R-CHA2DS2VASc score has shown good calibration and discriminative power in the prediction of thromboembolism for HCM patients. It should be considered as a potential decision support tool for HCM patients during clinical practice.
Collapse
Affiliation(s)
- Ziqiong Wang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Hang Liao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Sen He
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China.
| | - Xiaoping Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China.
| |
Collapse
|
10
|
Peng H, Sun Z, Chen H, Zhang Y, Ding X, Zhao XQ, Li H. Usefulness of the CHA 2DS 2-VASc Score to Predict Adverse Outcomes in Acute Coronary Syndrome Patients Without Atrial Fibrillation Undergoing Percutaneous Coronary Intervention. Am J Cardiol 2019; 124:476-484. [PMID: 31235063 DOI: 10.1016/j.amjcard.2019.05.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/27/2019] [Accepted: 05/07/2019] [Indexed: 12/20/2022]
Abstract
The prognostic value of the CHA2DS2-VASc score in acute coronary syndrome (ACS) patients without atrial fibrillation (AF) who underwent percutaneous coronary intervention remains uncertain. We examine the association of the CHA2DS2-VASc score and major adverse cardiovascular events (MACE) in this population and compared its risk prediction with 2 other commonly used risk scores (Global Registry of Acute Coronary Events [GRACE] and thrombolysis in myocardial infarction [TIMI]). A total of 3,745 consecutive ACS patients without AF who underwent percutaneous coronary intervention during 2013 to 2017 were classified into 4 groups according to the CHA2DS2-VASc score: low (0 to 1), moderate (2 to 3), high (4 to 5), and very high (>5). Incidences of MACE including cardiovascular death, nonfatal myocardial infarction, or stroke in-hospital and during a median follow-up of 33 months were compared among the 4 groups. Receiver-operating characteristic curves were generated to compare CHA2DS2-VASc with GRACE and TIMI for risk prediction. The incidences of in-hospital MACE (3.5%, 6.6%, 7.6%, and 9.1%, p <0.001) and mid-term follow-up MACE (4.5%, 7.1%, 13.1%, and 16.1%, p <0.001) were significantly higher as the CHA2DS2-VASc score increased. The CHA2DS2-VASc score was an independent predictor of subsequent MACE (hazard ratio = 1.31, 95% CI 1.24 to 1.39, p <0.001), and the very high-risk score group showed 3.8-fold increased risk of MACE than the low-risk score group. Receiver-operating characteristic curves showed that the CHA2DS2-VASc score was comparable to the GRACE score and to TIMI-STEMI, but, better than the TIMI-NSTEMI/unstable angina pectoris score in terms of predicting MACE. In conclusion, higher CHA2DS2-VASc score was independently associated with increased risk of MACE in the ACS patients without AF who underwent PCI.
Collapse
|
11
|
CHA 2DS 2-VASc and R 2-CHA 2DS 2-VASc scores predict in-hospital and post-discharge outcome in patients with myocardial infarction. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2018; 14:391-398. [PMID: 30603029 PMCID: PMC6309841 DOI: 10.5114/aic.2018.79869] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 11/19/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction The CHA2DS2-VASc and R2-CHA2DS2-VASc scores were initially designed to evaluate the risk of cerebrovascular events in patients with atrial fibrillation. However, these scales consist of parameters which are well known as general risk factors for cardiovascular events. Aim To assess the role of the CHA2DS2-VASc and R2-CHA2DS2-VASc scores in predicting outcome of patients with myocardial infarction (MI). Material and methods We enrolled 212 consecutive patients with both ST-elevation and non-ST-elevation MI referred for primary percutaneous coronary intervention (PCI). Patients were divided into two groups depending on the CHA2DS2-VASc score: ≤ 3 (low score) and > 3 points (high score). Results The group with a CHA2DS2-VASc score > 3 points consisted of 93 (44%) patients. Follow-up was available in 200 (94.3%) patients with median duration of 10 (Q1: 6; Q3: 13) months. During the follow-up all-cause mortality was greater in patients from the high score group (21%) compared to patients with lower scores (8%) (p = 0.009). Recurrent MI was found in 4% of patients from the low score group and in 13% of patients from the high score group (p = 0.024). The combined endpoint of cardiovascular mortality, recurrent non-fatal MI and non-fatal stroke occurred in 13% of lower score patients and in 30% of patients with a score > 3 points (p = 0.002). In a Cox regression model both scores were predictors of all-cause mortality with a hazard ratio of 1.31 per 1 point increase for the CHA2DS2-VASc score (p = 0.004) and 1.36 for the R2-CHA2DS2-VASc score (p < 0.001). Conclusions The CHA2DS2-VASc and R2-CHA2DS2-VASc scores predict in-hospital and post-discharge outcome in patients with acute MI undergoing primary PCI.
Collapse
|
12
|
Ueberham L, Dagres N, Potpara TS, Bollmann A, Hindricks G. Pharmacological and Non-pharmacological Treatments for Stroke Prevention in Patients with Atrial Fibrillation. Adv Ther 2017; 34:2274-2294. [PMID: 28956288 PMCID: PMC5656712 DOI: 10.1007/s12325-017-0616-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Indexed: 02/06/2023]
Abstract
Atrial fibrillation (AF) is associated with significant risk of stroke and other thromboembolic events, which can be effectively prevented using oral anticoagulation (OAC) with either vitamin K antagonists (VKAs) or non-VKA oral anticoagulants (NOACs) dabigatran, rivaroxaban, apixaban, or edoxaban. Until recently, VKAs were the only available means for OAC treatment. NOACs had similar efficacy and were safer than or as safe as warfarin with respect to reduced rates of hemorrhagic stroke or other intracranial bleeding in the respective pivotal randomized clinical trials (RCTs) of stroke prevention in non-valvular AF patients. Increasing “real-world” evidence on NOACs broadly confirms the results of the RCTs. However, individual patient characteristics including renal function, age, or prior bleeding should be taken into account when choosing the OAC with best risk–benefit profile. In patients ineligible for OACs, surgical or interventional stroke prevention strategies should be considered. In patients undergoing cardiac surgery for other reasons, the left atrial appendage excision, ligation, or amputation may be the best option. Importantly, residual stumps or insufficient ligation may result in even higher stroke risk than without intervention. Percutaneous left atrial appendage occlusion, although requiring minimally invasive access, failed to demonstrate reduced ischemic stroke events compared to warfarin. In this review article, we summarize current treatment options and discuss the strengths and major limitations of the therapies for stroke risk reduction in patients with AF.
Collapse
Affiliation(s)
- Laura Ueberham
- Department of Electrophysiology, HELIOS Heart Center Leipzig, Leipzig, Germany.
| | - Nikolaos Dagres
- Department of Electrophysiology, HELIOS Heart Center Leipzig, Leipzig, Germany
| | - Tatjana S Potpara
- Cardiology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Andreas Bollmann
- Department of Electrophysiology, HELIOS Heart Center Leipzig, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, HELIOS Heart Center Leipzig, Leipzig, Germany
| |
Collapse
|
13
|
Tian Y, Yang C, Liu H. CHA 2DS 2-VASc score as predictor of ischemic stroke in patients undergoing coronary artery bypass grafting and percutaneous coronary intervention. Sci Rep 2017; 7:11404. [PMID: 28900266 PMCID: PMC5595984 DOI: 10.1038/s41598-017-11923-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 08/31/2017] [Indexed: 12/21/2022] Open
Abstract
Ischemic stroke following coronary revascularization procedures remains one of the most potentially devastating complications. CHA2DS2-VASc score has been widely used for stroke risk stratification in AF patients. The aim of this nationwide study was to examine the association between the CHA2DS2-VASc score and ischemic stroke following coronary revascularization procedures. We identified patients undergoing coronary revascularization procedures, coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), using the electronic Hospitalization Summary Reports. Logistic regression models were applied to evaluate the association of CHA2DS2-VASc score with the risk of post-procedural ischemic stroke. We identified 54,714 patients undergoing CABG and 263,063 patients undergoing PCI from 2013 to 2015. The CHA2DS2-VASc score had a positive graded association with the risk of post-procedural ischemic stroke in both CABG and PCI (P for trend <0.001). The adjusted risk of post-procedural ischemic stroke increased by an estimated 122.4% (odds ratio [OR], 2.22; 95% confidence interval [CI], 2.11–2.35) and 34.7% (OR, 1.35; 95% CI, 1.31–1.39) for each additional 1 point in the CHA2DS2-VASc score in CABG and PCI, respectively. In conclusion, these findings suggested that CHA2DS2-VASc score was an independent predictor of the development of post-procedural ischemic stroke in patients undergoing CABG and PCI.
Collapse
Affiliation(s)
- Yaohua Tian
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No. 38 Xueyuan Road, 100191, Beijing, China
| | - Chenlu Yang
- Department of Maternal and Child Health, School of Public Health, Peking University, No. 38 Xueyuan Road, 100191, Beijing, China
| | - Hui Liu
- Medical Informatics Center, Peking University, No. 38 Xueyuan Road, 100191, Beijing, China. .,National Healthcare Data Center, Affiliated to National Center for Medical Service Administration, No. 38 Xueyuan Road, 100191, Beijing, China.
| |
Collapse
|
14
|
Guerra F, Scappini L, Maolo A, Campo G, Pavasini R, Shkoza M, Capucci A. CHA2DS2-VASc risk factors as predictors of stroke after acute coronary syndrome: A systematic review and meta-analysis. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 7:264-274. [DOI: 10.1177/2048872616673536] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background: Stroke is a rare but serious complication of acute coronary syndrome. At present, no specific score exists to identify patients at higher risk. The aim of the present study is to test whether each clinical variable included in the CHA2DS2-VASc score retains its predictive value in patients with recent acute coronary syndrome, irrespective of atrial fibrillation. Methods: The meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. All clinical trials and observational studies presenting data on the association between stroke/transient ischemic attack incidence and at least one CHA2DS2-VASc item in patients with a recent acute coronary syndrome were considered in the analysis. Atrial fibrillation diagnosis was also considered. Results: The whole cohort included 558,193 patients of which 7108 (1.3%) had an acute stroke and/or transient ischemic attack during follow-up (median nine months; 1st–3rd quartile 1–12 months). Age and previous stroke had the highest odds ratios (odds ratio 2.60; 95% confidence interval 2.21–3.06 and odds ratio 2.74; 95% confidence interval 2.19–3.42 respectively), in accordance with the two-point value given in the CHA2DS2-VASc score. All other factors were positively associated with stroke, although with lower odds ratios. Atrial fibrillation, while present in only 11.2% of the population, confirmed its association with an increased risk of stroke and/or transient ischemic attack (odds ratio 2.04; 95% confidence interval 1.71–2.44). Conclusions: All risk factors included in the CHA2DS2-VASc score are associated with stroke/ transient ischemic attack in patients with recent acute coronary syndrome, and retain similar odds ratios to what already seen in atrial fibrillation. The utility of CHA2DS2-VASc score for risk stratification of stroke in patients with acute coronary syndrome remains to be determined.
Collapse
Affiliation(s)
- Federico Guerra
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital ‘Ospedali Riuniti’, Italy
| | - Lorena Scappini
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital ‘Ospedali Riuniti’, Italy
| | - Alessandro Maolo
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital ‘Ospedali Riuniti’, Italy
| | - Gianluca Campo
- Cardiology Department, Università degli Studi di Ferrara, Ospedale Sant’Anna, Italy
| | - Rita Pavasini
- Cardiology Department, Università degli Studi di Ferrara, Ospedale Sant’Anna, Italy
| | - Matilda Shkoza
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital ‘Ospedali Riuniti’, Italy
| | - Alessandro Capucci
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital ‘Ospedali Riuniti’, Italy
| |
Collapse
|
15
|
Hudzik B, Szkodziński J, Hawranek M, Lekston A, Poloński L, Gąsior M. CHA2DS2-VASc score is useful in predicting poor 12-month outcomes following myocardial infarction in diabetic patients without atrial fibrillation. Acta Diabetol 2016; 53:807-15. [PMID: 27339195 PMCID: PMC5014889 DOI: 10.1007/s00592-016-0877-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 06/08/2016] [Indexed: 12/22/2022]
Abstract
AIMS TIMI risk score and GRACE risk model are widely available and accepted scores for risk assessment in STEMI patients and include predictors of poor outcomes. CHA2DS2-VASc is a validated score for predicting embolic/stroke risk in patients with non-valvular atrial fibrillation. Its components contribute to the worse prognosis following myocardial infarction. The advantage of the CHA2DS2-VASc score in comparison with other risk scores is that it provides a comprehensive, fast, and simple method for physicians in risk evaluation that requires no calculators or computers. Therefore, we have set out to examine the prognostic significance of CHA2DS2-VASc score following STEMI in diabetic patients without AF. METHODS A total of 472 patients with diabetes mellitus and STEMI undergoing primary PCI were enrolled. Based on the estimated CHA2DS2-VASc score, the study population was divided into three groups: group 1 (N = 111) with a moderate CHA2DS2-VASc score of 2 or 3; group 2 (N = 257) with a high CHA2DS2-VASc score of 4 or 5; and group 3 (N = 104) with a very high CHA2DS2-VASc score of 6 or higher. RESULTS In diabetic patients with STEMI, the median of CHA2DS2-VASc score was 4 (interquartile range 3-5). In-hospital mortality rate was similar across three groups. CHA2DS2-VASc score was not a risk factor of in-hospital mortality. ROC analysis revealed good diagnostic value of CHA2DS2-VASc score in predicting long-term mortality (AUC 0.62 95 % CI 0.57-0.66 P = 0.0003) and stroke (AUC 0.75 95 % CI 0.71-0.79 P = 0.0003), but no value in predicting long-term myocardial infarction. CHA2DS2-VASc score was an independent predictor of 12-month mortality and stroke. One-point increment in CHA2DS2-VASc score was associated with an increase in the risk of 12-month death by 24 % and for 12-month stroke by 101 %. CONCLUSIONS In diabetic patients with STEMI and no previous AF, median CHA2DS2-VASc score was high (4 points) and predicted 12-month death and stroke. However, it failed to predict in-hospital death and 12-month MI. CHA2DS2-VASc score had a similar discrimination performance in predicting 12-month mortality as TIMI risk score and a better discrimination performance in predicting 12-month stroke than TIMI risk score. Thus, it can serve as an additive tool in identifying high-risk patients that require aggressive management.
Collapse
Affiliation(s)
- Bartosz Hudzik
- Third Department of Cardiology, Silesian Center for Heart Disease, SMDZ in Zabrze, Medical University of Silesia in Katowice, Curie-Sklodowska 9, 41-800, Zabrze, Poland.
| | - Janusz Szkodziński
- Third Department of Cardiology, Silesian Center for Heart Disease, SMDZ in Zabrze, Medical University of Silesia in Katowice, Curie-Sklodowska 9, 41-800, Zabrze, Poland
| | - Michal Hawranek
- Third Department of Cardiology, Silesian Center for Heart Disease, SMDZ in Zabrze, Medical University of Silesia in Katowice, Curie-Sklodowska 9, 41-800, Zabrze, Poland
| | - Andrzej Lekston
- Third Department of Cardiology, Silesian Center for Heart Disease, SMDZ in Zabrze, Medical University of Silesia in Katowice, Curie-Sklodowska 9, 41-800, Zabrze, Poland
| | - Lech Poloński
- Third Department of Cardiology, Silesian Center for Heart Disease, SMDZ in Zabrze, Medical University of Silesia in Katowice, Curie-Sklodowska 9, 41-800, Zabrze, Poland
| | - Mariusz Gąsior
- Third Department of Cardiology, Silesian Center for Heart Disease, SMDZ in Zabrze, Medical University of Silesia in Katowice, Curie-Sklodowska 9, 41-800, Zabrze, Poland
| |
Collapse
|
16
|
Predictive ability of the CHADS2and CHA2DS2-VASc scores for stroke after transcatheter aortic balloon-expandable valve implantation: an Italian Transcatheter Balloon-Expandable Valve Implantation Registry (ITER) sub-analysis. Eur J Cardiothorac Surg 2016; 50:867-873. [DOI: 10.1093/ejcts/ezw199] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 04/09/2016] [Indexed: 01/07/2023] Open
|
17
|
García Seara J, Gude Sampedro F, Martínez Sande JL, Fernández López XA, González Melchor L, López López A, Bouzas Cruz N, Alvarez Alvarez B, Riziq-Yousef Abumuaileq R, Iglesias Alvarez D, González Juanatey JR. RETRACTED ARTICLE: Long-term mortality prediction of CHA2DS2VASc and HATCH scores in a cohort of patients with typical atrial flutter. Clin Res Cardiol 2015. [DOI: 10.1007/s00392-015-0913-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
18
|
Podolecki T, Lenarczyk R, Kowalczyk J, Swierad M, Swiatkowski A, Jedrzejczyk E, Chodor P, Zielinska T, Kalarus Z. Stroke and death prediction with CHA2DS2-vasc score after myocardial infarction in patients without atrial fibrillation. J Cardiovasc Med (Hagerstown) 2015; 16:497-502. [DOI: 10.2459/jcm.0000000000000241] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
19
|
Gary T, Pichler M, Schilcher G, Hafner F, Hackl G, Rief P, Eller P, Brodmann M. Elevated Blood Urea Nitrogen is Associated With Critical Limb Ischemia in Peripheral Arterial Disease Patients. Medicine (Baltimore) 2015; 94:e948. [PMID: 26091458 PMCID: PMC4616554 DOI: 10.1097/md.0000000000000948] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
As renal function is often impaired in atherosclerosis patients, accelerating atherosclerosis per se and creating a vicious cycle, we investigated the association of blood urea nitrogen (BUN) and critical limb ischemia (CLI) in peripheral arterial occlusive disease (PAOD) patients. Our cross-sectional study included 1521 PAOD patients, with normal and impaired renal function treated at our institution from 2005 to 2010. Patients on renal replacement therapy were excluded. The cohort was divided into tertiles according to the serum BUN levels. An optimal cutoff value for the continuous BUN was calculated by applying a receiver-operating curve analysis to discriminate between CLI and non-CLI. In our cohort, CLI increased significantly with an increase in BUN (13.1% in the first tertile, 18.7% in the second tertile, 29.0% in the third tertile, P for trend < 0.001). A BUN of 17.7 mg/dL was identified as an optimal cutoff. Accordingly, there were 2 groups of patients: 636 patients with BUN ≤ 17.7 and 885 patients with BUN > 17.7. CLI was more frequent in BUN > 17.7 patients (342 [38.6%]) than in BUN ≤ 17.7 patients (134 [21.1%]) (P < 0.001); the same applied to prior myocardial infarction (45 [5.1%] vs 15 [2.4%], P = 0.007) and congestive heart failure (86 [9.7%] vs 31 [4.9%], P < 0.001). A BUN > 17.7 was associated with an odds ratio of 1.6 (95% confidence interval: 1.3-1.9, P < 0.001) for CLI even after the adjustment for other established vascular risk factors such as age ≥ 75 and type 2 diabetes. An increased BUN is significantly associated with a high risk for CLI and other vascular endpoints. The BUN is an easily determinable, broadly available, and inexpensive marker that could be used to identify patients at high risk for vascular endpoints.
Collapse
Affiliation(s)
- Thomas Gary
- From the Division of Angiology (TG, FH, GH, PR, PE, MB); Division of Oncology (MP); and Division of Nephrology (GS), Department of Internal Medicine, Medical University Graz, Graz, Austria
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Álvarez-Álvarez B, Raposeiras-Roubín S, Abu-Assi E, Cambeiro-González C, Gestal-Romaní S, López-López A, Bouzas-Cruz N, Castiñeira-Busto M, Saidhodjayeva O, Redondo-Diéguez A, Pereira López E, García-Acuña JM, González-Juanatey JR. Is 6-month GRACE risk score a useful tool to predict stroke after an acute coronary syndrome? Open Heart 2014; 1:e000123. [PMID: 25544887 PMCID: PMC4275768 DOI: 10.1136/openhrt-2014-000123] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 08/13/2014] [Accepted: 11/04/2014] [Indexed: 11/29/2022] Open
Abstract
Objectives The risk of stroke after an acute coronary syndrome (ACS) has increased. The aim of this study was to do a comparative validation of the 6-month GRACE (Global Registry of Acute Coronary Events) risk score and CH2DS2VASc risk score to predict the risk of post-ACS ischaemic stroke. Methods This was a retrospective study carried out in a single centre with 4229 patients with ACS discharged between 2004 and 2010 (66.9±12.8 years, 27.9% women, 64.2% underwent percutaneous coronary intervention). The primary end point is the occurrence of an ischaemic stroke during follow-up (median 4.6 years, IQR 2.7–7.1 years). Results 184 (4.4%) patients developed an ischaemic stroke; 153 (83.2%) had sinus rhythm and 31 (16.9%) had atrial fibrillation. Patients with stroke were older, with higher rates of hypertension, diabetes, previous stroke and previous coronary artery disease. The HR for CHA2DS2VASc was 1.36 (95% CI, 1.27 to 1.48, p<0.001) and for GRACE, HR was 1.02(95% CI, 1.01 to 1.03, p<0.001). Both risk scores show adequate discriminative ability (c-index 0.63±0.02 and 0.60±0.02 for CHA2DS2VASc and GRACE, respectively). In the reclassification method there was no difference (Net Reclassification Improvement 1.98%, p=0.69). Comparing moderate-risk/high-risk patients with low-risk patients, both risk scores showed very high negative predictive value (98.5% for CHA2DS2VASc, 98.1% for GRACE). The sensitivity of CHA2DS2VASc score was higher than the GRACE risk score (95.1% vs 87.0%), whereas specificity was lower (14.4% vs 30.2%). Conclusions The 6-month GRACE model is a clinical risk score that facilitates the identification of individual patients who are at high risk of ischaemic stroke after ACS discharge.
Collapse
Affiliation(s)
- Belén Álvarez-Álvarez
- Department of Cardiology , University Clinical Hospital of Santiago de Compostela , Santiago de Compostela , Spain
| | - Sergio Raposeiras-Roubín
- Department of Cardiology , University Clinical Hospital of Santiago de Compostela , Santiago de Compostela , Spain
| | - Emad Abu-Assi
- Department of Cardiology , University Clinical Hospital of Santiago de Compostela , Santiago de Compostela , Spain
| | - Cristina Cambeiro-González
- Department of Cardiology , University Clinical Hospital of Santiago de Compostela , Santiago de Compostela , Spain
| | - Santiago Gestal-Romaní
- Department of Cardiology , University Clinical Hospital of Santiago de Compostela , Santiago de Compostela , Spain
| | - Andrea López-López
- Department of Cardiology , University Clinical Hospital of Santiago de Compostela , Santiago de Compostela , Spain
| | - Noelia Bouzas-Cruz
- Department of Cardiology , University Clinical Hospital of Santiago de Compostela , Santiago de Compostela , Spain
| | - María Castiñeira-Busto
- Department of Cardiology , University Clinical Hospital of Santiago de Compostela , Santiago de Compostela , Spain
| | - Ozoda Saidhodjayeva
- Department of Cardiology , University Clinical Hospital of Santiago de Compostela , Santiago de Compostela , Spain
| | - Alfredo Redondo-Diéguez
- Department of Cardiology , University Clinical Hospital of Santiago de Compostela , Santiago de Compostela , Spain
| | - Eva Pereira López
- Department of Cardiology , University Clinical Hospital of Santiago de Compostela , Santiago de Compostela , Spain
| | - José María García-Acuña
- Department of Cardiology , University Clinical Hospital of Santiago de Compostela , Santiago de Compostela , Spain
| | - José Ramón González-Juanatey
- Department of Cardiology , University Clinical Hospital of Santiago de Compostela , Santiago de Compostela , Spain
| |
Collapse
|
21
|
Lau YC, Lip GYH. Management of Atrial Fibrillation in Patients With Kidney Disease. J Atr Fibrillation 2014; 6:989. [PMID: 27957055 DOI: 10.4022/jafib.989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 03/27/2014] [Accepted: 03/27/2014] [Indexed: 11/10/2022]
Abstract
The increasing burden of Chronic Kidney Disease (CKD) is highly relevant to cardiologists, as cardiovascular mortality is 10-30 times higher amongst people with End-stage Renal Disease (ESRD), comparing with general population. One of the commonest associations is the increased frequency of atrial fibrillation (AF) amongst those experiencing CKD. Overall, we know that AF is the most common cardiac arrhythmia. AF leads to a substantial risk of mortality and morbidity, from stroke and thromboembolism, heart failure, reduced cognitive function and impaired quality of life. However, most clinical trials in AF (for example, for stroke prevention in AF with anticoagulation therapy) have largely excluded patients with significant renal impairment. In this review article, we will focus on stroke prevention in AF, and the clinical impact of CKD and its implications for management.
Collapse
Affiliation(s)
- Yee C Lau
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom
| | - Gregory Y H Lip
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom
| |
Collapse
|
22
|
Cohen A, Le Heuzey J. Comment évaluer le risque ischémique et hémorragique cérébral dans la fibrillation atriale ? Place des approches morphologiques et biologiques. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2014. [DOI: 10.1016/s1878-6480(14)71485-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|