Coronary Artery Disease
Prediction of Coronary Artery Disease Severity Using CHADS2 and CHA2DS2-VASc Scores and a Newly Defined CHA2DS2-VASc-HS Score

https://doi.org/10.1016/j.amjcard.2013.11.056Get rights and content

As the CHADS2 and CHA2DS2-VASc scores include similar risk factors for the development of coronary artery disease (CAD), they may provide crucial information regarding the severity of coronary artery lesions and the risk of thromboembolism. To increase the likelihood of determining CAD severity, we formulated the CHA2DS2-VASc-HS score comprising hyperlipidemia and smoking in addition to the components of the CHA2DS2-VASc score and male instead of female gender. We aimed to investigate whether these 3 risk scores can be used to predict CAD severity. A total of 407 consecutive patients who underwent coronary angiography were enrolled in the study. Presence of >50% stenosis in a coronary artery was assessed as significant CAD. Of the patients, 87 had normal coronary angiograms and served as group 1. The remaining 320 patients with coronary stenosis were further classified into 2 groups according to CAD with stenosis of <50% or ≥50%: 123 patients with mild CAD as group 2 and 197 patients with severe CAD as group 3. The CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-HS scores were significantly different among the 3 groups. The CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-HS scores correlated significantly with the number of diseased vessels (r = 0.406, p <0.001; r = 0.308, p <0.001; and r = 0.533, p <0.001, respectively) and the Gensini score (r = 0.383, p <0.001; r = 0.300, p <0.001; and r = 0.500, p <0.001, respectively). The CHA2DS2-VASc-HS score was found to be the best scoring scheme to predict CAD severity in the area under the curve comparison of these scoring systems. For prediction of severe CAD, the cut-off value of CHA2DS2-VASc-HS score was >2 with a sensitivity of 85.2% and a specificity of 57.5% (area under the curve 0.802, 95% confidence interval 0.760 to 0.839, p <0.001). In conclusion, our findings suggest that the CHADS2, CHA2DS2-VASc, and especially CHA2DS2-VASc-HS scores could be considered predictive of the risk of severe CAD.

Section snippets

Methods

This was a single-center study in which a total of 407 consecutive patients who were admitted for diagnostic CAG were prospectively enrolled. All study patients were referred for CAG as outpatients because of the symptoms suggestive of CAD and/or abnormal noninvasive stress tests based on exercise electrocardiographic testing or myocardial perfusion imaging test. Patients who had acute coronary syndrome, acute heart failure, acute ischemic stroke or transient ischemic attack (TIA), previous

Results

The study population consisted of 407 patients (mean age 61 ± 10 years, 113 women [28%]), of whom 87 had normal coronary arteries and were selected as the control group (group 1). The remaining 320 patients with coronary stenosis were further classified into 2 groups: 123 patients with CAD with stenosis of <50% as mild CAD group (group 2) and 197 patients with CAD with stenosis of ≥50% as severe CAD group (group 3). A comparison of the baseline demographics and characteristics of the 3 groups

Discussion

The major findings of the present report were (1) the CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-HS risk scores were increased in patients with mild and severe CAD, (2) the CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-HS scores were correlated significantly with the number of diseased vessels and Gensini score, and (3) the CHA2DS2-VASc-HS score was found to be the best score scheme to predict CAD severity in comparison of ROC curves and a score >2 may predict CAD severity.

Atherosclerotic cardiovascular

Disclosures

The authors have no conflicts of interest to disclose.

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