title: CHA2DS2-VASc score is useful in predicting poor 12-month outcomes following myocardial infarction in diabetic patients without atrial fibrillation.
abstract: OBJECTIVE
  TIMI risk score and GRACE risk model are widely available and accepted scores for risk assessment in STEMI patients and include predictors of poor outcomes. CHA2DS2-VASc is a validated score for predicting embolic/stroke risk in patients with non-valvular atrial fibrillation. Its components contribute to the worse prognosis following myocardial infarction. The advantage of the CHA2DS2-VASc score in comparison with other risk scores is that it provides a comprehensive, fast, and simple method for physicians in risk evaluation that requires no calculators or computers. Therefore, we have set out to examine the prognostic significance of CHA2DS2-VASc score following STEMI in diabetic patients without AF.
  
  
  METHODS
  A total of 472 patients with diabetes mellitus and STEMI undergoing primary PCI were enrolled. Based on the estimated CHA2DS2-VASc score, the study population was divided into three groups: group 1 (N = 111) with a moderate CHA2DS2-VASc score of 2 or 3; group 2 (N = 257) with a high CHA2DS2-VASc score of 4 or 5; and group 3 (N = 104) with a very high CHA2DS2-VASc score of 6 or higher.
  
  
  RESULTS
  In diabetic patients with STEMI, the median of CHA2DS2-VASc score was 4 (interquartile range 3-5). In-hospital mortality rate was similar across three groups. CHA2DS2-VASc score was not a risk factor of in-hospital mortality. ROC analysis revealed good diagnostic value of CHA2DS2-VASc score in predicting long-term mortality (AUC 0.62 95 % CI 0.57-0.66 P = 0.0003) and stroke (AUC 0.75 95 % CI 0.71-0.79 P = 0.0003), but no value in predicting long-term myocardial infarction. CHA2DS2-VASc score was an independent predictor of 12-month mortality and stroke. One-point increment in CHA2DS2-VASc score was associated with an increase in the risk of 12-month death by 24 % and for 12-month stroke by 101 %.
  
  
  CONCLUSIONS
  In diabetic patients with STEMI and no previous AF, median CHA2DS2-VASc score was high (4 points) and predicted 12-month death and stroke. However, it failed to predict in-hospital death and 12-month MI. CHA2DS2-VASc score had a similar discrimination performance in predicting 12-month mortality as TIMI risk score and a better discrimination performance in predicting 12-month stroke than TIMI risk score. Thus, it can serve as an additive tool in identifying high-risk patients that require aggressive management.
authors.affiliation: Third Department of Cardiology, Silesian Center for Heart Disease, SMDZ in Zabrze, Medical University of Silesia in Katowice, Curie-Sklodowska 9, 41-800, Zabrze, Poland. bartekh@mp.pl.
authors.forename: Bartosz
authors.initials: B
authors.lastname: Hudzik
authors.affiliation: Third Department of Cardiology, Silesian Center for Heart Disease, SMDZ in Zabrze, Medical University of Silesia in Katowice, Curie-Sklodowska 9, 41-800, Zabrze, Poland.
authors.forename: Janusz
authors.initials: J
authors.lastname: Szkodziński
authors.affiliation: Third Department of Cardiology, Silesian Center for Heart Disease, SMDZ in Zabrze, Medical University of Silesia in Katowice, Curie-Sklodowska 9, 41-800, Zabrze, Poland.
authors.forename: Michal
authors.initials: M
authors.lastname: Hawranek
authors.affiliation: Third Department of Cardiology, Silesian Center for Heart Disease, SMDZ in Zabrze, Medical University of Silesia in Katowice, Curie-Sklodowska 9, 41-800, Zabrze, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Lekston
authors.affiliation: Third Department of Cardiology, Silesian Center for Heart Disease, SMDZ in Zabrze, Medical University of Silesia in Katowice, Curie-Sklodowska 9, 41-800, Zabrze, Poland.
authors.forename: Lech
authors.initials: L
authors.lastname: Poloński
authors.affiliation: Third Department of Cardiology, Silesian Center for Heart Disease, SMDZ in Zabrze, Medical University of Silesia in Katowice, Curie-Sklodowska 9, 41-800, Zabrze, Poland.
authors.forename: Mariusz
authors.initials: M
authors.lastname: Gąsior
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D063305:Organ Dysfunction Scores; D018570:Risk Assessment
keywords: CHA2DS2-VASc; Diabetes mellitus; Prognosis; Risk score; STEMI