Cha2ds2-vasc Score and Clinical Outcomes of Patients with Acute Coronary Syndrome - The 63rd Annual Conference of the Israel Heart Society in association with the Israel Society of Cardiothoracic Surgery 12-13 April 2016, David Intercontinental Hotel, Tel-Aviv, Israel

Zach Rozenbaum ¹ Avishay Elis ^2,3 Meital Shlezinger ⁴ Ilan Goldenberg ^3,4 Avi Leader ⁵ Morris Mosseri ^3,6 David Pereg ^3,6

¹Department of Internal Medicine D, Sourasky Medical Center, Tel Aviv
²Department of Medicine, Beilinson Hospital, Rabin Medical Center, PetachTikva
³Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv
⁴Department of Cardiology, Sheba Medical Center, Tel hashomer, Tel hashomer
⁵Department of Internal Medicine A, Meir Medical Center, Kfar Saba
⁶Department of Cardiology, Meir Medical Center, Kfar Saba

Introduction: The CHA2DS2-VASc score has been recommended for the assessment of thromboembolic risk in patients with atrial fibrillation or flutter. The current study was aimed to assess the association of the CHA2DS2-VASc score with clinical outcomes in patients with ACS.

Methods: Included in the study were patients with ACS enrolled in the Acute Coronary Syndrome Israeli biennial Surveys (ACSIS) during 2000-2013. Patients were divided into 4 groups according to their CHA2DS2-VASc score (0 or 1, 2 or 3, 4 or 5, and above 5). The primary endpoint was 1-year all-cause mortality.

Results: The 13,422 patients had a mean age of 63.5±13 years and included 25.8% females. Higher CHA2DS2-VASc score was associated with a significant increase in 1-year mortality. Patients with a CHA2DS2-VASc score >5 had the highest 1-year mortality risk that was 6-fold higher compared to patients with a score of 0 to 1. (Hazard ratio=6, 95% CI=4.1-8.8, p<0.0001). However, even an intermediate CHA2DS2-VASc score of 2-3 was associated with a significant 2.6-fold increase in 1-year mortality. Despite their high mortality risk, patients with a higher CHA2DS2-VASc score were less frequently selected for an invasive strategy with an early coronary angiogram and subsequent angioplasty and were less commonly treated with the guideline-based cardiovascular medications.

Conclusions: CHA2DS2-VASc is a simple and readily available score which can be used for early risk stratification of ACS patients. Higher CHA2DS2-VASc score identifies high-risk patients that may be overlooked by existing scores. These patients are less frequently selected for an invasive strategy and are undertreated with the guideline-based medical therapy. Our findings suggest that the CHA2DS2-VASc score may be used together with the GRACE score for an improved risk assessment of ACS patients.