CHADS2-VA2Sc Skorunun Akut Koroner Sendrom Hastalarında 5 Yıllık Tüm Nedenli Mortaliteyi Öngördürücü Değeri

Year 2021, , 312 - 321, 29.06.2021

Ömer Faruk Çırakoğlu

https://doi.org/10.31832/smj.859171

Abstract

Amaç: Çalışmamızda akut koroner sendrom (AKS) tanılı hastalarda, atriyal fibrilasyon hastalarında inme riskinin skorlanmasında kullanılan CHADS2-VA2Sc skorunun 5 yıllık tüm nedenli mortaliteyi öngördürücü değerini araştırmayı amaçladık.
Gereç ve Yöntemler: Ocak 2014 ve Şubat 2015 tarihleri arasında merkezimizde AKS tanısıyla takip edilen 251 hasta ardışık olarak çalışmaya dahil edildi. Hastaların CHADS2-VA2Sc skorları taburculuk öncesi hesaplandı ve skorlara göre ≤1, 2-4, ≥5 olmak üzere üç grupta incelendiler. Primer sonlanım noktası tüm nedenli mortalite olarak belirlendi. Hastalar medyan 62 ay (25.-75. persantil: 42-69 ay) takip edildi. Mortalitenin bağımsız öngördürücü parametlerini saptamak için çok değişkenli Cox regresyon analizi yapıldı.
Bulgular: Çalışmaya dahil edilen 251 hastadan takip süresince toplamda 82 hasta (%32.7) ölmüştür. 5 yıllık tüm nedenli mortalite CHADS2-VA2Sc skoru ≥5 olan hasta grubunda diğer tertillerden anlamlı olarak daha yüksek saptanmıştır (%3.7 vs %22.4 vs %71.4). Kaplan-Meier sağkalım analizinde CHADS2-VA2Sc skoru ≥5 olan hastalar için önemli ölçüde daha düşük 5 yıllık sağkalım oranları gösterildi. Bağımsız prediktörlerin saptanması için iki ayrı modelde yapılan Cox regresyon analizinde SYNTAX skoru (SS), CHADS2-VA2Sc skoru (sürekli değişken) (Hazard ratio [HR]: 1.570, %95 güven aralığı [GA]:1.358-1.815, P<0.001), ve CHADS2-VA2Sc skorunun ≥5 olması (HR:4.710, %95 GA: 2.997-7.403, P <0.001) 5 yıllık tüm nedenli mortalitenin bağımsız prediktörleri olarak saptandı.
Sonuç: Çalışmamızda yüksek CHADS2-VA2Sc skoruna sahip hastaların 5 yıllık uzun dönem takipte artmış mortalite riskine sahip olduğu ortaya konmuştur. Herhangi bir hesaplayıcı algoritmaya ihtiyaç duyulmayan CHADS2-VA2Sc skor hesabının, AKS hastalarında uzun dönem mortalitenin bağımsız öngördürücüsü olarak kullanılabilecek basit, pratik ve değerli bir skorlama sistemi olabileceği gösterilmiştir.

Keywords

CHADS2-VA2Sc skoru, akut koroner sendrom, 5-yıllık mortalite

Supporting Institution

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Project Number

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Thanks

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Predictive Value of CHADS2-VA2Sc Score for 5-Year All-Cause Mortality in Acute Coronary Syndrome Patients.

Abstract

Objective: In our study, we aimed to investigate the predictive value of the CHADS2-VA2Sc score, which is used for scoring the risk of stroke in patients with atrial fibrillation, for 5-year all-cause mortality in patients with acute coronary syndrome (ACS).
Materials and Methods: Patients who were diagnosed with ACS between January 2014 and February 2015 in our center were consecutively included in this study. The CHADS2-VA2Sc scores of the patients were calculated before discharge and were examined in three groups as ≤1, 2-4, and ≥5. The primary endpoint was determined as all-cause mortality. Patients were followed for a median of 62 months (25th-75th percentile: 42-69 months). Multivariate Cox regression analysis was performed to determine independent predictors of mortality.
Results: Of the 251 patients included in the study, a total of 82 patients (32.7%) died during the follow-up period. The 5-year all-cause mortality was significantly higher in the patient with CHADS2-VA2Sc score ≥5 than the other groups (3.7% vs 22.4% vs 71.4%). Kaplan-Meier survival analysis demonstrated significantly lower 5-year survival rates for patients with a CHADS2-VA2Sc score ≥5. Multivariate Cox regression analysis performed in two separate models to identify independent predictors: SYNTAX score (SS), CHADS2-VA2Sc score (continuous variable) (Hazard ratio [HR]:1.570, 95% confidence interval [CI]:1.358-1.815, P<0.001), and CHADS2-VA2Sc score ≥5 (HR:4.710, 95% CI:2.997-7.403, P<0.001) were determined as independent predictors of 5-year all-cause mortality.
Conclusion: It has been shown that the CHADS2-VA2Sc score calculation, which does not require any computational algorithm, can be a simple, practical, and valuable scoring system that can be used as an independent predictor of long-term mortality in ACS patients.

Keywords

CHADS2-VA2Sc score, acute coronary syndrome, 5-year mortality

Project Number

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References

• 1. Benjamin EJ, Muntner P, Bittencourt MS. Heart disease and stroke statistics-2019 update: a report from the American Heart Association. Circulation 2019;139:e56-e528.
• 2. Nichols M, Townsend N, Scarborough P, Rayner M. Trends in age-specific coronary heart disease mortality in the European Union over three decades: 1980–2009. Eur Heart J 2013;34:3017–3027.
• 3. Collinson J, Flather MD, Fox KA, Findlay I, Rodrigues E, Dooley P, et al. Clinical outcomes risk stratification and practice patterns of unstable angina and myocardial infarction without ST elevation: Prospective Registry of Acute Ischaemic Syndromes in the UK (PRAIS-UK). Eur Heart J. 2000;21:1450–1457.
• 4. Eagle KA, Goodman SG, Avezum A, Budaj A, Sullivan CM, López-Sendón J, et al. Practice variation and missed opportunities for reperfusion in ST-segment-elevation myocardial infarction: findings from the Global Registry of Acute Coronary Events (GRACE). Lancet 2002;359:373-377.
• 5. Yan AT, Tan M, Fitchett D, Chow CM, Fowlis RA, McAvinue TG, et al. One-year outcome of patients after acute coronary syndromes (from the Canadian Acute Coronary Syndromes Registry). Am J Cardiol. 2004;94:25–29.
• 6. Fox KA, Carruthers KF, Dunbar DR, Graham C, Manning JR, De Raedt H, et al. Underestimated and under-recognized: the late consequences of acute coronary syndrome (GRACE UK-Belgian Study). Eur Heart J 2010;31:2755-2764.
• 7. Poçi D, Hartford M, Karlsson T, Herlitz J, Edvardsson N, Caidahl K. Role of the CHADS2 score in acute coronary syndromes: risk of subsequent death or stroke in patients with and without atrial fibrillation. Chest 2012;141:1431–1440.
• 8. Zhou X, Cao K, Kou S, Shencheng QU, Li H, Yu Y, et al. Usefulness of CHADS2 score for prognostic stratification of patients with coronary artery disease: A systematic review and meta-analysis of cohort studies. Int J Cardiol 2017;228:906-911.
• 9. Chua S-K, Lo H-M, Chiu C-Z, Shyu K-G. Use of CHADS2 and CHA2DS2-VASc scores to predict subsequent myocardial infarction, stroke, and death in patients with acute coronary syndrome: data from taiwan acute coronary syndrome full spectrum registry. PLoS One 2014;9(10):e111167.
• 10. Ma X, Shao Q, Dong L, Cheng Y, Lv S, Shen H et al. Prognostic value of CHADS2 and CHA2DS2-VASc scores for post-discharge outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Medicine 2020;99(30); p e21321
• 11. O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, De Lemos JA, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013;127:e362-e425.
• 12. Amsterdam EA, Wenger NK, Brindis RG, Casey DE, Ganiats TG, Holmes DR, et al. 2014 AHA/ACC Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014;64:e139-e228.
• 13. Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. 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;137(2):263–272.
• 14. Fox KA, Dabbous OH, Goldberg RJ, Pieper KS, Eagle KA, Van de Werf F, et al. Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE). BMJ 2006;333:1091.
• 15. Lip GY, Frison L, Halperin JL, Lane DA. Identifying patients at high risk for stroke despite anticoagulation: a comparison of contemporary stroke risk stratification schemes in an anticoagulated atrial fibrillation cohort. Stroke 2010;41:2731–8.
• 16. Cole JH, Miller JI III, Sperling LS, Weintraub WS. Long-term follow-up of coronary artery disease presenting in young adults. J Am Coll Cardiol 2003;41:521-528.
• 17. Pancholy SB, Shantha GP, Patel T, Cheskin LJ. Sex differences in short-term and long-term all-cause mortality among patients with ST-segment elevation myocardial infarction treated by primary percutaneous intervention: a meta-analysis. JAMA Intern Med 2014;174:1822–1830.
• 18. Isaksson RM, Jansson JH, Lundblad D, Naslund U, Zingmark K, Eliasson M. Better long-term survival in young and middle-aged women than in men after a first myocardial infarction between 1985 and 2006: an analysis of 8,630 patients in the Northern Sweden MONICA study.BMC Cardiovasc Disord 2011;11:1.
• 19. Nauta ST, Deckers JW, Akkerhuis KM, van Domburg RT. Short- and long-term mortality after myocardial infarction in patients with and without diabetes. changes from 1985 to 2008. Diabetes Care 2012;35:2043–2047.
• 20. Chehab, O.; Qannus, A.S.; Eldirani, M.; Hassan, H.; Tamim, H.; Dakik, H.A. Predictors of In-Hospital Mortality in Patients Admitted with Acute Myocardial Infarction in a Developing Country. Cardiol Res. 2018;9;293–299.
• 21. Hurtado-Martinez J, Pinar-Bermudez E, Teruel-Carrillo F, Gimeno-Blanes JR, Lacunza-Ruiz J, Valdesuso R, et al. In-hospital and long-term mortality in women with acute myocardial infarction treated by primary angioplasty [in Spanish]. Rev Esp Cardiol 2006;59(11):1113-1122.
• 22. Kosuge M, Kimura K, Kojima S, Sakamoto T, Ishihara M, Asada Y, et al. Japanese acute coronary syndrome study (JACSS) investigators. Sex differences in early mortality of patients undergoing primary stenting for acute myocardial infarction. Circ J 2006;70(3):217–21.
• 23. Deckers JW, van Domburg RT, Akkerhuis M, Nauta ST. Relation of admission glucose levels, short- and long-term (20-year) mortality after acute myocardial infarction. Am J Cardiol 2013;112(9):1306–1310.
• 24. Pedersen OD, Bagger H, Kober L, Torp-Pedersen C. The occurrence and prognostic significance of atrial fibrillation/flutter following acute myocardial infarction. TRACE Study group. TRAndolapril Cardiac Evalution. Eur Heart J 1999;20:748–54..
• 25. Serruys PW, Morice MC, Kappetein AP, Colombo A, Holmes DR, Mack MJ, et al. Percutaneous coronary intervention vs. coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med 2009;360:961-72.
• 26. Chan YH, Yiu KH, Lau KK, Yiu YF, Li SW, Lam TH, et al. The CHADS2 and CHA2DS2-VASc scores predict adverse vascular function, ischemic stroke and cardiovascular death in high-risk patients without atrial fibrillation: role of incorporating PR prolongation. Atherosclerosis 2014;237(2):504–513..
• 27. Yau JW, Teoh H, Verma S. Endothelial cell control of thrombosis. BMC Cardiovasc Disord 2015;15:130.
• 28. Kuvin JT, Patel AR, Sliney KA, Pandian NG, Rand WM, Udelson JE, et al. Peripheral vascular endothelial function testing as a noninvasive indicator of coronary artery disease. J Am Coll Cardiol 2001;38:1843–9.
• 29. Kim J, Cha MJ, Lee DH, Lee HS, Nam CM, Nam HS, et al. The association between cerebral atherosclerosis and arterial stiffness in acute ischemic stroke. Atherosclerosis 2011;219:887–91.
• 30. Crandall MA, Horne BD, Day JD, Anderson JL, Muhlestein JB, Crandall BG, Weiss JP, Lappe DL, Bunch TJ. Atrial fibrillation and CHADS2 risk factors are associated with highly sensitive C‐reactive protein incrementally and independently. Pacing Clin Electrophysiol 2009;32:648–652.
• 31. Maehama T, Okura H, Imai K, Yamada R, Obase K, Saito K, et al. Usefulness of CHADS2 score to predict C-reactive protein, left atrial blood stasis, and prognosis in patients with nonrheumatic atrial fibrillation. Am J Cardiol 2010;106:535.
• 32. Negi SI, Greener I, Anand A, Dudley SCJ Jr. A circulating biomarker risk-prediction model correlates with CHADS-2 risk score in chronic atrial fibrillation. IJC Metab Endocr 2015;6:24–6.
• 33. Mueller C, Buettner HJ, Hodgson JD, et al. Inflammation and long-term mortality after non-ST-elevation acute coronary syndrome treated with a very early invasive strategy in 1042 consecutive patients. Circulation 2002;105:1412–1415.
• 34. Rozenbaum, Z, Elis, A, Shuvy, M. CHA2DS2-VASc score and clinical outcomes of patients with acute coronary syndrome. Eur J Intern Med 2016;36:57–61.
• 35. Tang EW, Wong CK, Herbison P. Global Registry of Acute Coronary Events (GRACE) hospital discharge risk score accurately predicts long-term mortality post acute coronary syndrome. Am Heart J 2007;153:29.