Fernando Scudiero1, Chiara Zocchi1, Elena De Vito1, Giuseppe Tarantini2, Rossella Marcucci3, Renato Valenti4, Angela Migliorini4, David Antoniucci4, Niccolò Marchionni1, Guido Parodi5. 1. Cardiovascular and Thoracic Department, Careggi University Hospital, Florence, Italy; Experimental and Clinical Medicine Department, University of Florence, Florence, Italy. 2. Cardiovascular and Thoracic Department, Padua University, Padua, Italy. 3. Experimental and Clinical Medicine Department, University of Florence, Florence, Italy. 4. Cardiovascular and Thoracic Department, Careggi University Hospital, Florence, Italy. 5. Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy. Electronic address: gparodi@uniss.it.
Abstract
BACKGROUND: The CHA2DS2-VASc score predicts stroke risk in patients with atrial fibrillation, but recently has been reported to have a prognostic role even in patients with ACS. We sought to assess the ability of the CHA2DS2-VASc score to predict the severity of coronary artery disease, high residual platelet reactivity and long-term outcomes in patients with acute coronary syndrome (ACS). METHODS: Overall, 1729 consecutive patients with ACS undergoing invasive management were included in this prospective registry. We assessed platelet reactivity via light transmittance aggregometry after clopidogrel loading. Patients were divided according to the CHA2DS2-VASc score: group A = 0, B = 1, C = 2, D = 3, E = 4 and F ≥ 5. RESULTS: Patients with higher CHA2DS2-VASc score were more likely to have a higher rate of multivessel CAD (37%, 47%, 55%, 62%, 67 and 75% in Group A, B, C, D, E and F; p < 0.001); moreover, CHA2DS2-VASc score correlated linearly with residual platelet reactivity (R = 0.77; p < 0.001). At long-term follow-up, estimated adverse event rates (MACCE: cardiac death, MI, stroke or any urgent coronary revascularization) were 3%, 8%, 10%, 14%, 19% and 24% in group A, B, C, D, E and F; p < 0.001. Multivariable analysis demonstrated CHA2DS2-VASc to be an independent predictor of severity of coronary artery disease, of high residual platelet reactivity and of MACCE. CONCLUSIONS: In a cohort of patients with ACS, CHA2DS2-VASc score correlated with coronary disease severity and residual platelet reactivity, and therefore it predicted the risk of long-term adverse events.
BACKGROUND: The CHA2DS2-VASc score predicts stroke risk in patients with atrial fibrillation, but recently has been reported to have a prognostic role even in patients with ACS. We sought to assess the ability of the CHA2DS2-VASc score to predict the severity of coronary artery disease, high residual platelet reactivity and long-term outcomes in patients with acute coronary syndrome (ACS). METHODS: Overall, 1729 consecutive patients with ACS undergoing invasive management were included in this prospective registry. We assessed platelet reactivity via light transmittance aggregometry after clopidogrel loading. Patients were divided according to the CHA2DS2-VASc score: group A = 0, B = 1, C = 2, D = 3, E = 4 and F ≥ 5. RESULTS:Patients with higher CHA2DS2-VASc score were more likely to have a higher rate of multivessel CAD (37%, 47%, 55%, 62%, 67 and 75% in Group A, B, C, D, E and F; p < 0.001); moreover, CHA2DS2-VASc score correlated linearly with residual platelet reactivity (R = 0.77; p < 0.001). At long-term follow-up, estimated adverse event rates (MACCE: cardiac death, MI, stroke or any urgent coronary revascularization) were 3%, 8%, 10%, 14%, 19% and 24% in group A, B, C, D, E and F; p < 0.001. Multivariable analysis demonstrated CHA2DS2-VASc to be an independent predictor of severity of coronary artery disease, of high residual platelet reactivity and of MACCE. CONCLUSIONS: In a cohort of patients with ACS, CHA2DS2-VASc score correlated with coronary disease severity and residual platelet reactivity, and therefore it predicted the risk of long-term adverse events.
Authors: Fernando Scudiero; Renato Valenti; Rossella Marcucci; Giuseppe D Sanna; Anna Maria Gori; Angela Migliorini; Raffaele Vitale; Betti Giusti; Elena De Vito; Giulia Corda; Rita Paniccia; Davide Zirolia; Mario E Canonico; Guido Parodi Journal: J Am Heart Assoc Date: 2020-09-04 Impact factor: 5.501