Key result
In patients with atrial fibrillation undergoing percutaneous coronary intervention, an increasing GRACE score was independently associated with a higher risk of major adverse cardiac events (HR 1.014), whereas the CHA2DS2-VASc score was not.
Why the study?
GRACE and CHA2DS2-VASc scores were developed for risk stratification in ACS and AF, respectively, but their predictive performance needed assessment in patients with AF undergoing PCI.
Does the GRACE score or CHA2DS2-VASc score better predict major adverse cardiac events in patients with atrial fibrillation undergoing percutaneous coronary intervention?
Observational (n=1,452)
No
Does the GRACE score or CHA2DS2-VASc score better predict major adverse cardiac events in patients with atrial fibrillation undergoing percutaneous coronary intervention?
Hazard Ratio: 1.014 (95% CI 1.008–1.02)
p-value: p=<0.001
In patients with atrial fibrillation undergoing PCI, the GRACE score is superior to the CHA2DS2-VASc score for predicting MACEs, ischemic stroke, and major bleeding, though both similarly predict all-cause mortality.
May refine MACE risk stratification in AF-PCI patients; leaves open whether GRACE should guide therapy.
Aims The GRACE and CHA2DS2-VASc risk score are developed for risk stratification in patients with acute coronary syndrome and AF, respectively. We aimed to assess the predictive performance of the GRACE score and CHA2DS2-VASc score among patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI).Methods Consecutive patients with a diagnosis of AF admitted to our hospital for PCI between January 2016 and December 2018 were included and followed up for at least 1 year. The primary endpoint was a composite of major adverse cardiac events (MACEs) including all-cause mortality, repeat revascularization, myocardial infarction, or ischaemic stroke.Results A total of 1452 patients were identified. Cox regression demonstrated that the GRACE (HR 1.014, 95% CI 1.008–1.020, p < 0.001) but not the CHA2DS2-VASc score was associated with the risk of MACEs. Both GRACE and CHA2DS2-VASc scores were predictive of all-cause mortality with HR of 1.028 (95% CI 1.020–1.037, p < 0.001) and 1.334 (95% CI 1.107–1.632, p = 0.003). Receiver operating characteristic analyses showed both scores had similar discrimination capacity for all-cause mortality (C-statistic: 0.708 for GRACE vs. 0.661 for CHA2DS2-VASc, p = 0.299). High GRACE score was also significantly associated with increased risk of ischaemic stroke (HR 1.018, 95% CI 1.005–1.031, p = 0.006) and major bleeding (HR 1.012, 95% CI 1.001–1.024, p = 0.039), whereas high CHA2DS2-VASc score was not.Conclusions High GRACE score but not CHA2DS2-VASc score were both associated with an increased risk of MACEs after PCI in patients with AF. The GRACE and CHA2DS2-VASc scores have similar predictive performance for predicting all-cause mortality.Key messages:In patients with AF undergoing PCI, increasing GRACE but not CHA2DS2-VASc scores was independently associated high risk of MACEs.The GRACE score could also help identify patients at higher risk of stroke and major bleeding.Both GRACE and CHA2DS2-VASc scores showed good ability in the prediction of all-cause mortality.
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Guo et al. (2021) conducted an observational in Atrial fibrillation undergoing percutaneous coronary intervention (n=1,452). GRACE score vs. CHA2DS2-VASc score was evaluated on Composite of major adverse cardiac events (MACEs) including all-cause mortality, repeat revascularization, myocardial infarction, or ischaemic stroke (HR 1.014, 95% CI 1.008-1.020, p=<0.001). In patients with atrial fibrillation undergoing percutaneous coronary intervention, an increasing GRACE score was independently associated with a higher risk of major adverse cardiac events (HR 1.014), whereas the CHA2DS2-VASc score was not.
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