title: Predictive accuracy of CHA2DS2-VASc and HAS-BLED scores in patients without atrial fibrillation undergoing percutaneous coronary intervention and discharged on dual antiplatelet therapy.
abstract: BACKGROUND
  The CHA2DS2-VASc and HAS-BLED are well-validated stroke risk prediction scores for atrial fibrillation (AF), but their role in risk stratification of major adverse cardiac events (MACEs) and major bleeding for non-AF patients undergoing percutaneous coronary intervention (PCI) is unknown.
  
  
  METHODS
  Consecutive patients without AF undergoing PCI at two Italian centers were analyzed with different measures of discrimination, net reclassification improvement and net prognostic benefit. MACE included all-cause death, myocardial infarction, destabilizing symptoms leading to hospitalization, and nonfatal stroke. Major bleeding was defined according to the TIMI classification.
  
  
  RESULTS
  Of 1437 subjects undergoing PCI, 1330 (mean age 63.6±10.9years, 75.7% male) fulfilled the inclusion criteria. During 2.7±1.2years of follow-up representing 3539 patient-years at risk, 187 patients had a MACE (5.3%/year) and 48 had a major bleeding (1.4%/year). The cumulative incidences of MACE were significantly stratified by both high CHA2DS2-VASc (P=0.020) or HAS-BLED (P<0.001) scores, whereas major bleeding episodes were not. The CHA2DS2-VASc and the HAS-BLED scores had similar C-statistics for MACE (0.56 vs 0.60; P=0.52) and major bleeding (0.63 vs 0.60; P=0.63). Compared with CHA2DS2-VASc, the HAS-BLED score more accurately reclassified events and no events both for MACE (NRI 8.21%) and major bleeding (NRI 6.85%).
  
  
  CONCLUSIONS
  In patients without AF undergoing PCI and discharged on dual antiplatelet therapy, the HAS-BLED score performed better than the CHA2DS2-VASc for the prediction of MACE. Although both scores predict MACE, their discrimination was modest. Conversely, both scores did not significantly predict major bleeding in non-AF patients undergoing PCI.
authors.affiliation: University of Catania, Ferrarotto Hospital, Catania, Italy. Electronic address: dcapodanno@gmail.com.
authors.forename: Davide
authors.initials: D
authors.lastname: Capodanno
authors.affiliation: Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Rossini
authors.affiliation: Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Musumeci
authors.affiliation: Carlo Poma Hospital, Mantova, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Lettieri
authors.affiliation: Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Senni
authors.affiliation: Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Orazio
authors.initials: O
authors.lastname: Valsecchi
authors.affiliation: University of Florida, College of Medicine-Jacksonville, Jacksonville, FL, USA.
authors.forename: Dominick J
authors.initials: DJ
authors.lastname: Angiolillo
authors.affiliation: University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom.
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation; D002423:Cause of Death / Q000639:trends; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: CHA(2)DS(2)-VASc; HAS-BLED; PCI; Stents