Key result
Adding renal dysfunction to the CHA2DS2-VASc score improved its predictive accuracy for 1-year MI, stroke, or death in ACS patients (AUC 0.70 vs 0.66, P<0.001).
Why the study?
Does adding renal dysfunction to the CHA2DS2-VASc score improve prognostic accuracy for adverse events in patients with acute coronary syndrome?
Cohort (n=3,031)
Yes
Does adding renal dysfunction to the CHA2DS2-VASc score improve prognostic accuracy for adverse events in patients with acute coronary syndrome?
Absolute Event Rate: 17.2% vs 3.4%
p-value: p=<0.001
Adding renal dysfunction (eGFR ≤ 60 mL/min/1.73 m²) to the CHA2DS2-VASc score significantly improves its prognostic accuracy for predicting 1-year MI, stroke, or death in patients with acute coronary syndrome.
May support renal-adjusted CHA2DS2-VASc for ACS risk stratification; leaves open prospective validation before clinical adoption.
AIM: CHA2 DS2 -VASc score has been proven to have great prognostic value in patients with acute coronary syndrome (ACS). We aimed to determine whether the addition of renal dysfunction in the CHA2 DS2 -VASc score would improve the prognostic impact of the scoring system to predict prognosis among ACS patients. METHODS: A total of 3031 ACS patients were prospectively enrolled at 39 hospitals and followed for 1 year. The patients were divided into three groups based on estimated glomerular filtration rate (eGFR) (group 1, eGFR>90; group 2, eGFR between 60 and 90; and group 3, eGFR<60 mL/min per 1.73 m(2) ). The occurrence of subsequent myocardial infarction (MI), stroke, or death was recorded. RESULTS: As renal function progressively decreased from group 1 to 3, the patients were, respectively older and had higher incidence of comorbidity, worse Killip classification, and less evidence-based medical therapies. The rate of subsequent MI, stroke or death increased from 3.4% in group 1 to 7.4% in group 2 and 17.2% in group 3 (P < 0.001). Renal dysfunction (eGFR<60 mL/min per 1.73 m(2) ) and CHA2 DS2 -VASc scores were both significant predictors of adverse events in multivariable regression analyses. Renal dysfunction can further stratify patients with CHA2 DS2 -VASc score of 0 or 1 into 3 groups with different adverse event rates (group 1, 3.0%; group 2, 4.1%; and group 3, 9.2%, P < 0.001). A new scoring system (R-CHA2 DS2 -VASc score) derived by assigning one more point for eGFR ≤ 60 mL/min per 1.73 m(2) to the CHA2 DS2 -VASc score could improve its predictive accuracy (area under the receiver operating curve, 0.70 vs. 0.66, P < 0.001). CONCLUSIONS: Renal dysfunction is a significant risk factor of future adverse events in ACS patients and may improve the prognostic impact of the CHA2 DS2 -VASc score.
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Chua et al. (2015) conducted a cohort in Acute coronary syndrome (ACS) (n=3,031). Renal dysfunction (eGFR < 60 mL/min per 1.73 m2) vs. Normal or mildly reduced renal function (eGFR > 60 mL/min per 1.73 m2) was evaluated on Subsequent myocardial infarction (MI), stroke, or death (p=<0.001). Adding renal dysfunction to the CHA2DS2-VASc score improved its predictive accuracy for 1-year MI, stroke, or death in ACS patients (AUC 0.70 vs 0.66, P<0.001).
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