Comparison Of Prognostic Values Of GRACE Risk Score And CHA₂DS₂-VASC Score In Patients With Acute Coronary Syndrome Complicating Atrial Fibrillation

Objects: This article is aimed to assess and compare the GRACE sore and CHA2DS2-VASc score in terms of predicting prognosis of patients with acute coronary syndromes(ACS) complicating atrial fibrillation(AF), in order to provide some references for clinicians to choose which score to assess risk of this kind of patients.Method: This is a retrospective observational study of 119 ACS patients complicating AF hospitalized in the cardiology department of Wuhan Union Hospital from January 1, 2013 to December 30, 2014.During 1 year follow-up, the primary endpoints are major cardiovascular adverse events(MACEs) and ischemic stroke events. The GRACE sores and CHA2DS2-VASc scores of these patients are calculated. Logistic regression analysis is used to find risk factors of MACEs within 30 days or 1 year. The two scores' receiver operating characteristic curves(ROC) and area under ROC curve(AUC) are analyzed for the diagnostic performance of predicting prognosis.Results:Of 119 patients included in the study, 24 have MACEs within 30 days. Left ventricular ejection fraction(LVEF) < 50% is an independent risk factor of MACEs occurred within 30 days. The GRACE risk score has a better predictive value(p = 0.003); the AUC is 0.699(95% CI:0.565-0.838). However, the CHA2DS2-VASC score for predicting the occurrence of MACEs within 30 days has no statistical significance(p = 0.546). 61 patients have MACEs during 1 year follow-up. LVEF < 50%, age ? 75 and elevation of troponin I are independent risk factors of MACEs occurred within 1 year. The GRACE score(p < 0.001) and the CHA2DS2-VASc score(p= 0.001) have a good predictive value; the AUC respectively is 0.739(95% CI: 0.650-0.815), 0.665(95% CI: 0.572-0.749). Ischemic stroke events occurred in 9 patients during 1 year follow-up. History of stroke and age?75 are independent risk factors of MACEs occurred within 1 year. CHA2DS2-VASC score demonstrates a good predictive value(p=0.001); its AUC is 0.741(95% CI: 0.653-0.814).But the GRACE score for predicting the occurrence of ischemic stroke events within 1 year is not statistically significant(p=0.546).Conclusion: As to ACS patients complicating AF, GRACE score has a better predictive value for MACEs occurred within 30 days than CHA2DS2-VASc score, but they have a similar predictive value for MACEs occurred within 1 year; CHA2DS2-VASc score has a better predictive value for the occurrence of ischemic stroke events within 1 year than GRACE score.