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

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

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

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