Topaz G, et al. - Researchers tested the hypothesis that CHA₂DS₂-VASc score improves risk stratification of low-risk chest-pain patients discharged after acute coronary syndrome (ACS) rule-out. In these patients, an association was shown between high CHA₂DS₂-VASc score (>3) and adverse outcomes.

Methods

• Researchers obtained medical records of patients who were admitted to internal medicine wards at a single medical center during 2010–2016 and discharged following an ACS rule-out.
• Based on the CHA₂DS₂-VASc score, patients were grouped: 0–1 (low), 2–3 (intermediate), >3 (high).
• Primary endpoint was occurrence of ACS at 1-year, and secondary outcomes included 30-day and 1-year all-cause mortality (ACM).

Results

• A total of 12,449 patients were included, and of those, low, intermediate, and high CHA₂DS₂-VASc scores were seen in 7,057 (57%), 3,781 (30%), and 1,611 (13%), respectively.
• Intermediate and high scores vs a low score were found to be related to significantly increased risk for 1-year ACS during the first year (OR: 2.89, 95% CI: 1.91–4.37, P < 0.01 and OR: 4.84, 95% CI: 3.02–7.74, P < 0.01, respectively).
• Researchers noted an association between each 1-point increase in CHA₂DS₂-VASc and a 37% increased risk for 1-year ACS.
• A higher CHA₂DS₂-VASc score was shown to be related to significantly higher 30-day ACM.
• Relative to a low score, 1.9 (95% CI: 1.1–3.4, P=0.03) and 4.4 (95% CI: 2.4–7.9, P < 0.01) were the hazard ratios for 30-day ACM for intermediate and high CHA₂DS₂-VASc scores, respectively.
• Data showed that each 1-point increase in CHA₂DS₂-VASc score was related to 43% increased risk for 30-day mortality.