| Chapter 1 Predictive Value of the CHA2DS2-VASc Score for in-hospital outcomes in patients With Acute Myocardial InfarctionBackgrounds:Acute myocardial infarction(AMI)is a common fatal cardiovascular emergency.With the active application of early reperfusion treatment,the risk of in-hospital death is significantly reduced.It is particularly important to make rapid stratification of AMI to formulate reperfusion treatment strategy.The risk score recommended by the guideline is complex,so there is an urgent need for a simple and effective scoring system.The CHA2DS2-VASc score contains important risk factors related to AMI,which is simple and easy to calculate,but there is insufficient evidence whether it can be used for in-hospital risk assessment of patients with AMI.Objectives:This study was undertaken to explore the accuracy of the CHA2DS2-VASc score for the outcomes of patients with acute myocardial infarction(AMI)in hospital.Methods:We retrospectively analyzed the data of 23728 patients from 162 centers in China PEACE-Retrospective Acute Myocardial Infarction Study.Patients were categorized into 3 groups according to the CHA2DS2-VASc:low score group(score 1-3),middle score group(score 4-6)and high score group(score 7-9).The in-hospital outcomes included major adverse cardiovascular events(MACE,including death or withdrawal from treatment,reinfarction,and ischemic stroke),death,death or withdrawal from treatment,reinfarction,heart failure,ischemic stroke,cardiogenic shock,major bleeding or blood transfusion,acute renal failure and malignant arrhythmia(ventricular fibrillation or ventricular tachycardia).A CHA2DS2-VASc score was incorporated into multivariate Cox regression analyses to determine its independent impact on in-hospital outcomes.The ROC curves were constructed,and the AUC was used to evaluate the predictive value of the CHA2DS2-VASc score for in-hospital mortality and death or withdrawal from treatment risk.Results:18324 STEMI(28.2%female)and 5404 NSTEMI(39.2%female)were enrolled.Patients with higher CHA2DS2-VASc scores showed higher in-hospital mortality and in-hospital complications(all P<0.0001).Following adjustment for baseline covariates,the top score group was associated with the highest in-hospital mortality(P<0.0001),the highest death or treatment withdrawal risk(P<0.0001)in addition to the highest MACE(P<0.0001)compared to other groups either in STEMI or NSTEMI.Meanwhile,with continual increments in the CHA2DS2-VASc scores,both the in-hospital mortality as well as the death or treatment withdrawal risk grew by 41%(P<0.0001),and the MACE increased by 37%(P<0.0001)in STEMI.Together with the in-hospital mortality increase of 35%(P<0.0001),the death or treatment withdrawal risk went up by 34%(P<0.0001),furthermore the MACE also showed an increase of 30%(P<0.0001)in NSTEMI.For in-hospital mortality and death or treatment withdrawal risk,the AUC of the CHA2DS2-VASc score was equivalent to the mini-GRACE score(0.667 vs.0.695,P=0.148,0.668 vs.0.701,P=0.046,0.652 vs.0.677,P=0.102)in NSTEMI.Regarding patients with STEMI,the CHA2DS2-VASc score was comparable to the mini-GRACE score in predicting in-hospital mortality(0.700 vs.0.718,P=0.08),but was inferior in predicting death or treatment abandonment as well as major adverse cardiovascular events against the mini-GRACE score(0.704vs.0.736,P<0.01,0.685 vs.0.707,P<0.01).Conclusions:The CHA2DS2-VASc score is an independent predictor of in-hospital outcomes for patients with AMI.Its predictive value was comparable with the mini-GRACE score,especially in NSTEMI,which could be used as a simple tool for early and rapid stratification of AMI patients.Chapter 2 Predictive value of the CHA2DS2-VASc score for predicting 1-year outcomes following acute Myocardial InfarctionBackgrounds Acute myocardial infarction(AMI)is a life-threatening cardiovascular disease,which can lead to high long-term mortality,high hospitalization rate and high disability rate.The risk stratification of patients before discharge is helpful to the formulation of long-term treatment strategies.At present,GRACE score and TIMI score can be used to predict the long-term risk of AMI,but their algorithm is complex and difficult to remember.The CHA2DS2-VASc score contains the similar risk factors of atherosclerotic disease,which is simple and easy to operate.But whether it can be used to evaluate the long-term risk of AMI patients is still uncertain.Objectives The aim of our study is to determine whether CHA2DS2-VASc score is a predictor for 1-year outcomes of patients with acute myocardial infarction(AMI).Methods Data of 4062 patients from 53 centers China PEACE-Prospective Acute Myocardial Infarction Study were analyzed retrospectively.The patients were categorized into 3 groups according to the CHA2DS2-VASc scores:the low score group(score 1～3),the middle score group(score 4～6)and the high score group(score 7～9).The 1-year outcomes included major adverse cardiovascular events(MACE,including death,stroke,rehospitalization for heart failure and nonfatal myocardial infarction),death,stroke,rehospitalization for heart failure and nonfatal myocardial infarction.The CHA2DS2-VASc score was incorporated into multivariate Cox regression analyses to determine its independent impact on 1-year outcomes.Receiver operating Characteristic(ROC)curves were constructed,and the area under the curve(AUC)was used to evaluate the predictive value of the CHA2DS2-VASc score for 1-year all-cause mortality and MACE,respectively.Results A total of 4062 patients(4372 STEMI and 790 NSTEMI)were included in the study.Patients with higher CHA2DS2-VASc scores had a higher 1-year outcomes and more complications(all P<0.0001).After adjustment of baseline covariates,the subjects in the high score group were associated with high risks of 1-year all-cause mortality(STEMI,P<0.05;NSTEMI,P<0.0001),nonfatal myocardial infarction(NSTEMI,P<0.05),stroke(STEMI,P<0.0001),rehospitalization for heart failure(STEMI,P<0.0001;NSTEMI,P<0.001)and MACE(STEMI 与 NSTEMI,both P<0.0001).Meanwhile,with incremental increasing in CHA2DS2-VASc scores,the in-hospital mortality of STEMI and NSTEMI patients increased by 28.3%(P<0.001)and 93.4%(P<0.0001),respectively,and the MACE increased by 43.2%(P<0.0001)and 55.8%(P<0.0001),respectively.The ROC curve showed that CHA2DS2-VASc score could well predict the incidence of MACE in AMI patients 1-year after discharge(P>0.05),but it was slightly inferior to GRACE score in predicting all-cause death(P<0.01).Conclusions The CHA2DS2-VASc score is a useful predictor for 1-year outcomes in patients with AMI.Its predictive value was comparable with the GRACE score in predicting MACE,which could be used as a simple tool for early and rapid outcome evaluation for AMI patients. |
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