CHADS2, CHA2DS2-VASc and HAS-BLED as predictors of outcome in patients with atrial fibrillation undergoing percutaneous coronary intervention.
BACKGROUND
CHADS2 and CHA2DS2-VASc scores are used to estimate thromboembolic risk in atrial fibrillation (AF). HAS-BLED is recommended for bleeding risk prediction. Their value in predicting the outcome of AF patients after percutaneous coronary intervention (PCI) is unknown. Thus, our aim was to assess whether these simple risk scores are useful in predicting outcome in these patients.


METHODS
AFCAS is an observational, multicenter, prospective registry including patients (n=929) with AF referred for PCI. Primary study endpoints were 1) all cause mortality; 2) major adverse events (all-cause mortality, myocardial infarction, repeat revascularization, stent thrombosis, transient ischemic attack, stroke or other arterial thromboembolism; MACCE); and 3) bleeding at 12 months follow-up. CHADS2 and CHA2DS2-VASc scores and a modified HAS-BLED (mHAS-BLED) score (omitting labile INR and liver function) were calculated.


RESULTS
Patients were distributed as follows: CHADS2 low 29.5%, intermediate 55.2%, high 15.3%; CHA2DS2-VASc low 9.6%, intermediate 46.0%, high 44.5%. A high CHA2DS2-VASc score was predictive of all-cause mortality (p=0.02), whereas CHADS2 was not. High CHA2DS2-VASc score predicted MACCE (HR 2.24, 95%CI 1.21-4.17, p=0.01), as did a high CHADS2 score (HR 1.60, 95%CI 1.05-2.45, p=0.029). Their predictive performance was only modest (C indexes 0.56-0.57). CHADS2 or CHA2DS2-VASc scores were not associated with bleeding. High mHAS-BLED scores (≥3) were not associated with any of the study outcomes.


CONCLUSIONS
High CHA2DS2-VASc score was the best predictor of thrombotic outcomes after PCI in a high risk AF population. High mHAS-BLED score was not predictive of bleeding events. More accurate, simple risk scores are needed.
Hemostasis laboratory, Finnish Red Cross Blood Service, Helsinki, Finland.
Marja K
MK
Puurunen
Heart Center, Turku University Hospital and University of Turku, Turku, Finland.
Tuomas
T
Kiviniemi
Medical Faculty, Martin Luther University Halle-Wittenberg, Germany.
Axel
A
Schlitt
Division of Cardiology, Laboratory of Interventional Cardiology, Ospedale Maggiore, Bologna, Italy.
Andrea
A
Rubboli
Medical Faculty, Martin Luther University Halle-Wittenberg, Germany.
Britta
B
Dietrich
Heart Center, Satakunta Central Hospital, Pori, Finland.
Pasi
P
Karjalainen
Department of Cardiology, Central Finland Central Hospital, Jyväskylä, Finland.
Kai
K
Nyman
Department of Medicine, Oulu University Hospital, Oulu, Finland.
Matti
M
Niemelä
University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom.
Gregory Y H
GY
Lip
Heart Center, Turku University Hospital and University of Turku, Turku, Finland. Electronic address: juhani.airaksinen@tyks.fi.
K E Juhani
KE
Airaksinen
D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D013923:Thromboembolism / Q000209:etiology; D016896:Treatment Outcome
Atrial fibrillation; CHA(2)DS(2)-VASc; CHADS(2); HAS-BLED; PCI; Risk scoring schemes