CHADS2, CHA2DS2-VASc and R2CHADS2 scores predict mortality in patients with coronary artery disease

Abstract

Few studies to date address the predictive ability of CHA₂DS₂-VASc and R₂CHADS₂ in CAD patients. Our aim is to investigate the prognostic performance of CHADS₂, CHA₂DS₂-VASc and R₂CHADS₂ scores in patients with coronary artery disease (CAD). Angiographically obstructive CAD patients were enrolled. The prognostic performance of the three risk scores was evaluated using Cox hazards models. In addition, we compared their predictive values by calculating C statistics, net reclassification improvement (NRI) and integrated discrimination improvement (IDI). The endpoints are death from any cause and cardiovascular death. Of 3295 subjects with CAD, the mean CHADS₂, CHA₂DS₂-VASc and R₂CHADS₂ scores are 1.2 ± 1.0, 2.4 ± 1.4, and 1.6 ± 1.4, respectively. The CHADS₂-guided risk classification is markedly distinct from CHA₂DS-₂-VASc- and R₂CHADS₂-guided ones. Over a median follow-up of 24 months, a total of 290 (rate 4.00/100 person-year) deaths occurred, and 163 (rate 2.2/100 person-year) were attributed to cardiovascular deaths. Event rates increase by CHADS₂, CHA₂DS₂-VASc and R₂CHADS₂ (P for trend <0.001). The multivariate analyses show 60, 111 and 82% higher risk of mortality per unit increase of CHADS₂, CHA₂DS₂-VASc and R₂CHADS₂ scores, respectively. Comparing with CHADS₂ score (c-statistic = 0.61), CHA₂DS₂-VASc (c-statistic 0.65, NRI 0.52 and IDI 0.06, P for all <0.05) and R₂CHADS₂ (c-statistic 0.66, NRI 0.43 and IDI 0.09, P for all <0.05) scores provide better discrimination and reclassification for mortality. Also, CHA₂DS₂-VASc and R₂CHADS₂ have comparable predictive ability of mortality to the GRACE score. The CHADS₂, CHA₂DS₂-VASc and R₂CHADS₂ scores are simple yet robust prognostic tools in CAD patients.

Keywords: CHA2DS2-VASc score; CHADS2 score; Coronary artery disease; GRACE score; Outcome; Renal dysfunction.