The prognostic role of the CHA₂DS₂-VASc score in patients with acute myocardial infarction receiving extracorporeal membrane oxygenation following out-of-hospital cardiac arrest

Aims: The CHA₂DS₂-VASc scoring system has been widely used for stroke risk stratification in patients with atrial fibrillation, yet evidence regarding its prognostic value in other critical settings remains limited. This study aimed to assess the utility of the CHA₂DS₂-VASc score in predicting mortality in patients with acute myocardial infarction (AMI) who received veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support following out-of-hospital cardiac arrest. Methods: This retrospective study included 41 patients with AMI requiring VA-ECMO after OHCA. Baseline demographics, clinical characteristics, and prognostic scores, including CHA₂DS₂-VASc, SAVE (Survival After Veno-Arterial ECMO), Glasgow Coma Scale (GCS), and acute physiology and chronic health evaluation (APACHE) II were recorded. Patients were categorized into three risk groups based on the CHA₂DS₂-VASc score: low (0 points), moderate (1 point), and high (≥2 points). According to the SAVE score, patients were classified into five risk groups: class I (≥5 points), class II (1–4 points), class III (−4 to 0 points), class IV (−9 to −5 points), and class V (≤−10 points). The primary outcome was in-hospital mortality. Results: The overall in-hospital mortality rate was 58.5%. Patients with high risk group had a significantly higher mortality risk (HR: 3.12, 95% CI: 1.28-7.63, p=0.008). The SAVE score had the highest diagnostic performance, with a sensitivity of 81.2% and specificity of 76.5% (AUC=0.80). CHA₂DS₂-VASc (AUC=0.74) and APACHE II (AUC=0.72) also demonstrated good predictive performance. While CHA₂DS₂-VASc maintained a balanced sensitivity (70.8%) and specificity (64.7%), APACHE II had higher sensitivity (75.7%) but lower specificity (58.8%). GCS demonstrated the lowest diagnostic performance (AUC=0.68). Conclusion: While the SAVE score, a risk model specifically designed for VA-ECMO, provides a strong prognostic evaluation, the CHA₂DS₂-VASc score could be a simple and easily applicable tool for early risk stratification in this high-risk population.