CHADS2, CHA2DS2-VASc and R2CHADS2scores predict mortality in patients with coronary artery disease.
Few studies to date address the predictive ability of CHA2DS2-VASc and R2CHADS2in CAD patients. Our aim is to investigate the prognostic performance of CHADS2, CHA2DS2-VASc and R2CHADS2scores in patients with coronary artery disease (CAD). Angiographically obstructive CAD patients were enrolled. The prognostic performance of the three risk scores was evaluated using Cox hazards models. In addition, we compared their predictive values by calculating C statistics, net reclassification improvement (NRI) and integrated discrimination improvement (IDI). The endpoints are death from any cause and cardiovascular death. Of 3295 subjects with CAD, the mean CHADS2, CHA2DS2-VASc and R2CHADS2scores are 1.2 ± 1.0, 2.4 ± 1.4, and 1.6 ± 1.4, respectively. The CHADS2-guided risk classification is markedly distinct from CHA2DS-2-VASc- and R2CHADS2-guided ones. Over a median follow-up of 24 months, a total of 290 (rate 4.00/100 person-year) deaths occurred, and 163 (rate 2.2/100 person-year) were attributed to cardiovascular deaths. Event rates increase by CHADS2, CHA2DS2-VASc and R2CHADS2(P for trend <0.001). The multivariate analyses show 60, 111 and 82% higher risk of mortality per unit increase of CHADS2, CHA2DS2-VASc and R2CHADS2scores, respectively. Comparing with CHADS2score (c-statistic = 0.61), CHA2DS2-VASc (c-statistic 0.65, NRI 0.52 and IDI 0.06, P for all <0.05) and R2CHADS2(c-statistic 0.66, NRI 0.43 and IDI 0.09, P for all <0.05) scores provide better discrimination and reclassification for mortality. Also, CHA2DS2-VASc and R2CHADS2have comparable predictive ability of mortality to the GRACE score. The CHADS2, CHA2DS2-VASc and R2CHADS2scores are simple yet robust prognostic tools in CAD patients.
Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China.
Fang-Yang
FY
Huang
Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China.
Bao-Tao
BT
Huang
Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China.
Xiao-Bo
XB
Pu
Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China.
Yong
Y
Yang
Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China.
Shi-Jian
SJ
Chen
Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China.
Tian-Li
TL
Xia
Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China.
Yi-Yue
YY
Gui
Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China.
Yong
Y
Peng
Department of Family Medicine, West China Hospital, Sichuan University, Chengdu, China.
Rui-Shuang
RS
Liu
Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China.
Yuanweixiang
Y
Ou
Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China.
Fei
F
Chen
Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China. zhuye1974@163.com.
Ye
Y
Zhu
Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China. hmaochen@vip.sina.com.
Mao
M
Chen
D000368:Aged; D016009:Chi-Square Distribution; D002681:China; D003324:Coronary Artery Disease / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods* / Q000592:standards*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
CHA2DS2-VASc score; CHADS2 score; Coronary artery disease; GRACE score; Outcome; Renal dysfunction