Role of the CHADS2 score in acute coronary syndromes - risk of subsequent death or stroke in patients with and without atrial fibrillation.
Chest. 2011 Oct 20;
Authors: Poçi D, Hartford M, Karlsson T, Herlitz J, Edvardsson N, Caidahl K
Abstract BACKGROUND:Atrial fibrillation (AF) is common in acute coronary syndromes (ACS). We aimed to describe the value of the CHADS(2) score as a risk assessment tool for mortality and stroke in ACS, irrespective of the presence or absence of AF. METHODS:Consecutive patients with ACS admitted to the coronary care unit were prospectively included in a risk stratification study. We calculated CHADS(2) score from the data collected at admission, and all patients were followed until January 1, 2007 or death. RESULTS:Of 2335 patients with ACS, 442 (71±8 years, 142 women) had AF. Their mean CHADS(2) score was 1.6±1.4, versus 1.0±1.1 in patients without AF (p<0.0001). The all-cause mortality at 10 years was strongly associated with CHADS(2) score in patients with AF (hazard ratio [HR] and 95% confidence interval per unit increase in the 6-grade CHADS(2) score 1.21 [1.07-1.36], p=0.002), but also in patients without AF (HR 1.38 [1.28-1.48], p<0.0001), after adjustment for potential confounders. The more complicated GRACE risk score provided a better prediction for short- and long-term mortality than the simpler CHADS(2) score (p<0.0001). Hospitalization for stroke was significantly associated with the CHADS(2) score in patients without (but not in those with) AF after adjustment (HR 1.46 [1.27-1.68], p<0.0001). CONCLUSIONS:In ACS, AF is associated with poor prognosis. The CHADS(2) score developed for AF has even greater prognostic value in non-AF patients, and may help to identify patients with high risk for subsequent stroke or death and a need for optimization of risk reducing treatment.
PMID: 22016485 [PubMed - as supplied by publisher]