title: CHA2DS2-VASc score and clinical outcomes of patients with acute coronary syndrome.
abstract: BACKGROUND
  The CHA2DS2-VASc score has been recommended for the assessment of thromboembolic risk in patients with atrial fibrillation.
  
  
  OBJECTIVE
  The CHA2DS2-VASc score may be associated with adverse outcomes in patients with ACS.
  
  
  METHODS
  Included were patients with ACS enrolled in the Acute Coronary Syndrome Israeli biennial Surveys (ACSIS) during 2000-2013. Patients were divided into 4 groups according to their CHA2DS2-VASc score (0 or 1, 2 or 3, 4 or 5, and >5). The primary endpoint was 1-year all-cause mortality.
  
  
  RESULTS
  The 13,422 patients had a mean age of 63.5±13years and included 25.8% females. Higher CHA2DS2-VASc score was associated with a significant increase in 1-year mortality. Patients with a CHA2DS2-VASc score >5 had the highest 1-year mortality risk that was 6-fold higher compared to patients with a score of 0 to 1 (hazard ratio=6, 95% CI=4.1-8.8, p<0.0001). However, even an intermediate CHA2DS2-VASc score of 2-3 was associated with a significant 2.6-fold increase in 1-year mortality. Patients with a higher CHA2DS2-VASc score were less frequently selected for an invasive strategy with an early coronary angiogram and subsequent angioplasty and were less commonly treated with the guideline-based medications. However, differences in outcomes remained significant following a multivariate analysis suggesting that these variations in therapy can only partially explain the differences in outcomes.
  
  
  CONCLUSIONS
  Higher CHA2DS2-VASc score identifies high-risk patients that may be overlooked by existing scores. Further studies are needed in order to evaluate whether the CHA2DS2-VASc score may be used together with the GRACE score for an improved risk assessment of ACS patients.
authors.affiliation: Department of Internal Medicine D, Tel Aviv, Sourasky Medical Center, Tel Aviv, Israel.
authors.forename: Zach
authors.initials: Z
authors.lastname: Rozenbaum
authors.affiliation: Department of Medicine, Beilinson Hospital, Rabin Medical Center, PetachTikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Avishay
authors.initials: A
authors.lastname: Elis
authors.affiliation: Heart Institute, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Mony
authors.initials: M
authors.lastname: Shuvy
authors.affiliation: Department of Cardiology, Sheba Medical Center, Tel HaShomer, Israel.
authors.forename: Dina
authors.initials: D
authors.lastname: Vorobeichik
authors.affiliation: Department of Cardiology, Sheba Medical Center, Tel HaShomer, Israel.
authors.forename: Nir
authors.initials: N
authors.lastname: Shlomo
authors.affiliation: Department of Cardiology, Sheba Medical Center, Tel HaShomer, Israel.
authors.forename: Meital
authors.initials: M
authors.lastname: Shlezinger
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Cardiology, Sheba Medical Center, Tel HaShomer, Israel.
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
authors.affiliation: Department of Internal Medicine A, Meir Medical Center, Kfar Saba, Israel.
authors.forename: Oded
authors.initials: O
authors.lastname: Kimhi
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Cardiology, Meir Medical Center, Kfar Saba, Israel. Electronic address: davidpe@post.tau.ac.il.
authors.forename: David
authors.initials: D
authors.lastname: Pereg
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality*; D000367:Age Factors; D000368:Aged; D000789:Angina, Unstable / Q000401:mortality*; D017130:Angioplasty; D017023:Coronary Angiography; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D005260:Female; D019983:Guideline Adherence; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D002546:Ischemic Attack, Transient / Q000453:epidemiology; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality*; D016491:Peripheral Vascular Diseases / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology
keywords: Acute coronary syndrome; Risk score; mortality