CHA2DS2-VASc Score and Clinical Outcomes of Patients with Chest Pain Discharged from Internal Medicine Wards Following Acute Coronary Syndrome Rule-Out

Background: Patients with chest pain deemed safe enough for discharge from internal medicine wards might still be at risk for adverse outcomes.

Hypothesis: The CHA2DS2-VASc score could improve risk stratification of low-risk chest pain patients discharged after ACS-rule-out.

Methods: Medical records were accessed of patients who were admitted to internal medicine wards at one medical center during 2010-2016, and who were discharged following an ACS-rule-out. Patients were classified according to the CHA2DS2-VASc score: 0-1 (low), 2-3 (intermediate), <3 (high score). The primary endpoint was the occurrence of ACS at 1-year. Thirty-day and 1-year all-cause mortality were secondary outcomes.

Results: Of 12,449 patients,7,057 (57%) had low, 3,781 (30%) intermediate and 1,611 (13%) high CHA2DS2-VASc scores. Compared to a low score, intermediate and high scores were associated with significantly increased risk for 1-year ACS during the first year: OR=2.89, 95%CI=1.91 to 4.37, p<0.01 and OR=4.84, 95%CI=3.02 to 7.74 p<0.01, respectively. Each 1-point increase in CHA2DS2-VASc was associated with a 37% increased risk for 1-year ACS. A higher CHA2DS2-VASc score was associated with significantly higher 30-day all-cause mortality. Hazard ratios for 30-day all-cause mortality were 1.9 (95% CI 1.1-3.4, p=0.03) and 4.4 (95% CI 2.4-7.9, p<0.01) for intermediate and high CHA2DS2-VASc scores, respectively, compared to a low score. Each 1-point increase in CHA2DS2-VASc score was associated with a 43% increased risk for 30-day mortality.

Conclusions: A high CHA2DS2-VASc score (>3) was associated with adverse outcomes among patients with chest pain who were discharged from internal medicine wards following ACS-rule-out.

Keywords: Chest pain; CHA2DS2-VASc score; Acute coronary syndrome (ACS)