CHADS₂ Scores Predict Adverse Clinical Events In Patients With Triple Vessel Coronary Disease

Background Triple-vessel disease/left main stem disease (TVD/LMD) is regarded as an independent predictor of poor outcome in patients with coronary heart disease (CHD). Although great progresses have been made in this field, it is still a controversial issue about how to determine the optimal therapeutic strategies for TVD/LMD among medication, percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG). As a main tool available for risk stratification for TVD/LMD patients in clinical practice, higher syntax score (SS) is considered to be associated with incremental rates of clinical adverse outcomes, therefore providing principle for the therapeutic strategy. Based on that, it has been recommended by ACCF/AHA/SCAI Guideline for TVD/LMD patients with SS>33 or even>23 to receive CABG, while PCI is a recommended choice for those with SS< 23. Nevertheless, in the real world, there are many TVD/LMD patients with high risk based on SS system rejecting surgical operation for various reasons. However, relative benign outcome can still be observed for those who receive PCI or pharmacotherapy only. Considering that the SS only involves the information of coronary anatomy but overlooks the clinical risk factors which are also regarded to contribute to the progress of CHD, it remains unclear which is comparatively more important for determination of poor outcomes in TVD/LMD patients between clinical risk factors and severity of coronary lesions.As a tool originally used to estimate the risk of stroke in individuals with atrial fibrillation (AF), CHADS2 score involves many similar risk factors for the development of CHD including congestive heart failure (CHF), hypertension, age≥75 years, type 2 diabetes, and previous stroke or transient ischemic accident (TIA). Therefore, the potential association between CHADS2 score and CHD has attracted great attention. It has been observed that CHADS2 score is not only associated with severity of coronary diseases, but has a moderate predictive ability for adverse clinical events in ACS patients. However, no report has explored the association of CHADS2 score with prognosis in TVD/LMD population. Thus, this study is to test the hypothesis that CHADS2 score might be a useful predictive tool for risk stratification in TVD/LMD patients based on 1 year follow up.Methods and results 995 patients with three vessels disease were retrospectively involved. The association of CHADS2 score with 1 year major adverse clinical events (MACEs) including all-cause death, re-hospitalization for heart failure, myocardial infarction, stroke and revascularization were investigated. A strong positive association between tertiles of CHADS2 (0 to 1,2 to 3, and 4 to 6) score and its each component including chronic heart failure, hypertension, older age, diabetes, and previous stroke could be observed. Also, increased tertiles of CHADS2 score was strongly associated with higher Syntax score (SS), impaired left ventricular ejection fraction, and reduced renal function. After adjusted the confounding factors, the tertiles of CHADS2 score (2 to 3 and 4 to 6, respectively) remained independent predictors of adverse events in separate multivariate Logistic Regression analysis. Results from Receiver operating characteristic (ROC) curves revealed CHADS2 score had similar performance with Syntax Score and Age,Creatinine Ejection Fraction Score but inferior to Clinical Syntax Score in predicting 1 year MACEs in TVD/LMD patients.Conclusion Our study revealed an association between CHADS2 score and prognosis in TVD/LMD patients. Along with findings in previous studies, our findings suggest that the value of the CHADS2 score may not be limited to their role in predicting the severity of coronary disease, but also for subsequent adverse events. In clinical setting, before related laboratory investigations available, CHADS2 score might be a potential tool to provide prognostic information and help physicians to identify their patientsat high risk initially.