Clinical Application of CHA2DS2-VASc versus GRACE Scores for Assessing the Risk of Long-term Ischemic Events in Atrial Fibrillation and Acute Coronary Syndrome or PCI
Background: Early risk stratification of patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI) has relevant implication for individualized management strategies. The CHA2DS2-VASc and GRACE ACS risk model are well-established r...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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IMR Press
2022-05-01
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| Series: | Reviews in Cardiovascular Medicine |
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| Online Access: | https://www.imrpress.com/journal/RCM/23/5/10.31083/j.rcm2305168 |
| _version_ | 1818239895383048192 |
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| author | Ran Mo Yan-min Yang Han Zhang Ni Suo Jing-yang Wang Si-qi Lyu |
| author_facet | Ran Mo Yan-min Yang Han Zhang Ni Suo Jing-yang Wang Si-qi Lyu |
| author_sort | Ran Mo |
| collection | DOAJ |
| description | Background: Early risk stratification of patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI) has relevant implication for individualized management strategies. The CHA2DS2-VASc and GRACE ACS risk model are well-established risk stratification systems. We aimed to assess their prognostic performance in AF patients with ACS or PCI. Methods: Consecutive patients with AF and ACS or referred for PCI were prospectively recruited and followed up for 3 years. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCEs), including cardiovascular mortality, myocardial infarction, ischemic stroke, systemic embolism and ischemia-driven revascularization. Results: Higher CHA2DS2-VASc (HR [hazard ratio] 1.184, 95% CI 1.091–1.284) and GRACE at discharge score (HR 1.009, 95% CI 1.004–1.014) were independently associated with increased risk of MACCEs. The CHA2DS2-VASc (c-statistics: 0.677) and GRACE at discharge (c-statistics: 0.699) demonstrated comparable discriminative capacity for MACCEs (p = 0.281) while GRACE at admission provided relatively lower discrimination (c-statistics: 0.629, p vs. CHA2DS2-VASc = 0.041). For predicting all-cause mortality, three models displayed good discriminative capacity (c-statistics: 0.750 for CHA2DS2-VASc, 0.775 for GRACE at admission, 0.846 for GRACE at discharge). A significant discrimination improvement of GRACE at discharge compared to CHA2DS2-VASc was detected (NRI = 45.13%). Conclusions: In the setting of coexistence of AF and ACS or PCI, CHA2DS2-VASc and GRACE at discharge score were independently associated with an increased risk of MACCEs. The GRACE at discharge performed better in predicting all-cause mortality. |
| first_indexed | 2024-12-12T13:04:49Z |
| format | Article |
| id | doaj.art-d8d6ffc17fa34070b7f13f1f8509e46d |
| institution | Directory Open Access Journal |
| issn | 1530-6550 |
| language | English |
| last_indexed | 2024-12-12T13:04:49Z |
| publishDate | 2022-05-01 |
| publisher | IMR Press |
| record_format | Article |
| series | Reviews in Cardiovascular Medicine |
| spelling | doaj.art-d8d6ffc17fa34070b7f13f1f8509e46d2022-12-22T00:23:42ZengIMR PressReviews in Cardiovascular Medicine1530-65502022-05-0123516810.31083/j.rcm2305168S1530-6550(22)00505-1Clinical Application of CHA2DS2-VASc versus GRACE Scores for Assessing the Risk of Long-term Ischemic Events in Atrial Fibrillation and Acute Coronary Syndrome or PCIRan Mo0Yan-min Yang1Han Zhang2Ni Suo3Jing-yang Wang4Si-qi Lyu5Emergency Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, ChinaEmergency Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, ChinaEmergency Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, ChinaEmergency Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, ChinaEmergency Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, ChinaEmergency Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, ChinaBackground: Early risk stratification of patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI) has relevant implication for individualized management strategies. The CHA2DS2-VASc and GRACE ACS risk model are well-established risk stratification systems. We aimed to assess their prognostic performance in AF patients with ACS or PCI. Methods: Consecutive patients with AF and ACS or referred for PCI were prospectively recruited and followed up for 3 years. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCEs), including cardiovascular mortality, myocardial infarction, ischemic stroke, systemic embolism and ischemia-driven revascularization. Results: Higher CHA2DS2-VASc (HR [hazard ratio] 1.184, 95% CI 1.091–1.284) and GRACE at discharge score (HR 1.009, 95% CI 1.004–1.014) were independently associated with increased risk of MACCEs. The CHA2DS2-VASc (c-statistics: 0.677) and GRACE at discharge (c-statistics: 0.699) demonstrated comparable discriminative capacity for MACCEs (p = 0.281) while GRACE at admission provided relatively lower discrimination (c-statistics: 0.629, p vs. CHA2DS2-VASc = 0.041). For predicting all-cause mortality, three models displayed good discriminative capacity (c-statistics: 0.750 for CHA2DS2-VASc, 0.775 for GRACE at admission, 0.846 for GRACE at discharge). A significant discrimination improvement of GRACE at discharge compared to CHA2DS2-VASc was detected (NRI = 45.13%). Conclusions: In the setting of coexistence of AF and ACS or PCI, CHA2DS2-VASc and GRACE at discharge score were independently associated with an increased risk of MACCEs. The GRACE at discharge performed better in predicting all-cause mortality.https://www.imrpress.com/journal/RCM/23/5/10.31083/j.rcm2305168atrial fibrillationacute coronary syndromepercutaneous coronary interventiongracecha2ds2-vasc score |
| spellingShingle | Ran Mo Yan-min Yang Han Zhang Ni Suo Jing-yang Wang Si-qi Lyu Clinical Application of CHA2DS2-VASc versus GRACE Scores for Assessing the Risk of Long-term Ischemic Events in Atrial Fibrillation and Acute Coronary Syndrome or PCI Reviews in Cardiovascular Medicine atrial fibrillation acute coronary syndrome percutaneous coronary intervention grace cha2ds2-vasc score |
| title | Clinical Application of CHA2DS2-VASc versus GRACE Scores for Assessing the Risk of Long-term Ischemic Events in Atrial Fibrillation and Acute Coronary Syndrome or PCI |
| title_full | Clinical Application of CHA2DS2-VASc versus GRACE Scores for Assessing the Risk of Long-term Ischemic Events in Atrial Fibrillation and Acute Coronary Syndrome or PCI |
| title_fullStr | Clinical Application of CHA2DS2-VASc versus GRACE Scores for Assessing the Risk of Long-term Ischemic Events in Atrial Fibrillation and Acute Coronary Syndrome or PCI |
| title_full_unstemmed | Clinical Application of CHA2DS2-VASc versus GRACE Scores for Assessing the Risk of Long-term Ischemic Events in Atrial Fibrillation and Acute Coronary Syndrome or PCI |
| title_short | Clinical Application of CHA2DS2-VASc versus GRACE Scores for Assessing the Risk of Long-term Ischemic Events in Atrial Fibrillation and Acute Coronary Syndrome or PCI |
| title_sort | clinical application of cha2ds2 vasc versus grace scores for assessing the risk of long term ischemic events in atrial fibrillation and acute coronary syndrome or pci |
| topic | atrial fibrillation acute coronary syndrome percutaneous coronary intervention grace cha2ds2-vasc score |
| url | https://www.imrpress.com/journal/RCM/23/5/10.31083/j.rcm2305168 |
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