Prognostic value of CHA(2)DS(2)-VASc score in predicting high SYNTAX score and in-hospital mortality for non-ST elevation myocardial infarction in patients without atrial fibrillation

Abstract

Objective: To evaluate the prognostic value of preprocedural CHA(2)DS(2)-VASc [congestive heart failure, hypertension, age >= 75 years (doubled), diabetes mellitus, previous stroke or transient ischemic attack (TIA) (doubled), vascular disease, age 65-74 years, female gender] score in predicting high SYNTAX (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) score and in-hospital mortality for non-atrial fibrillation (AF) patients presenting with non-ST elevation myocardial infarction (NSTEMI). The CHA(2)DS(2)-VASc score used to determine thromboembolic risks in AF was recently reported to predict major adverse clinical outcomes in patients with the acute coronary syndrome, irrespective of AF. Methods: A total of 906 patients with a diagnosis of NSTEMI who underwent coronary angiography were retrospectively enrolled and divided into three groups according to their SYNTAX scores (low, intermediate, and high). The CHA(2)DS(2)-VASc score of each patient was calculated. Results: SYNTAX score had a significant positive correlation with the CHA(2)DS(2)-VASc score (r=0.320; p<0.001) in the Spearman correlation analysis. The CHA(2)DS(2)-VASc score [Odds ratio, 1.445; 95% confidence interval (CI), 1.268-1.648, p<0.001], left ventricular ejection fraction, creatinine, C-reactive protein, and high-density and low-density lipoprotein cholesterol levels were demonstrated to be independent predictors of high SYNTAX score. The CHA(2)DS(2)-VASc score [Hazard ratio (HR), 1.867; 95% CI: 1.462-2.384; p<0.001], the SYNTAX score (HR, 1.049; p=0.003), and age (HR, 1.057; p=0.002) were independently associated with higher risk of in-hospital mortality in a multiple Cox-regression model. KaplanMeier survival curves stratified by the CHA(2)DS(2)-VASc score (<4 vs. >= 4) also showed that higher CHA(2)DS(2)-VASc scores were associated with higher in-hospital mortality. Conclusions: In non-AF patients with NSTEMI, CHA(2)DS(2)-VASc and SYNTAX scores are useful for prognosis assessment and can be used to identify patients at higher risk for in-hospital mortality.