A Novel Risk Scoring System to Predict Cardiovascular Death in Patients With Acute Myocardial Infarction: CHA2DS2-VASc-CF Score
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Published on: August 9, 2024
Harun Kundi1, Emrullah Kiziltunc1, Ahmet Korkmaz1
11 Cardiology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey.
Insights
A new CHA2DS2-VASc-CF score effectively predicts long-term cardiovascular death in acute myocardial infarction (AMI) patients. This enhanced score, incorporating smoking and family history, offers valuable prognostic data for interventional cardiologists.
Area of Science:
- Cardiology
- Clinical Risk Stratification
Background:
- The CHA2DS2-VASc score is used to assess stroke risk in atrial fibrillation but its prognostic validity in acute myocardial infarction (AMI) is less established.
- Accurate risk stratification is crucial for managing AMI patients and optimizing long-term cardiovascular outcomes.
Purpose of the Study:
- To evaluate the long-term prognostic value of the CHA2DS2-VASc score in patients following AMI.
- To develop and validate a novel scoring system, the CHA2DS2-VASc-CF score, by incorporating additional risk factors like smoking and family history into the existing CHA2DS2-VASc score for improved AMI prognostication.
Main Methods:
- A cohort of 4373 consecutive patients with AMI (including STEMI and non-STEMI) undergoing cardiac catheterization between 2009 and 2016 was analyzed.
- Multivariate logistic regression was employed to identify predictors of cardiovascular death during follow-up.
- The predictive performance of the CHA2DS2-VASc-CF score was assessed using sensitivity and specificity.
Main Results:
- The CHA2DS2-VASc-CF score, along with the original CHA2DS2-VASc score, major adverse cardiac events, smoking, older age, hypertension, and family history, were significantly associated with cardiovascular death.
- Lower left ventricular ejection fraction and glomerular filtration rate were also observed in patients who experienced cardiovascular death.
- The CHA2DS2-VASc-CF score demonstrated good predictive ability, with a sensitivity of 78.4% and specificity of 76.4% at a cutoff score of >3 for predicting long-term cardiovascular death.
Conclusions:
- The novel CHA2DS2-VASc-CF score demonstrates strong prognostic validity for long-term cardiovascular death in all AMI patients, irrespective of treatment or AMI type.
- This easily calculable score provides significant prognostic information, aiding clinicians in identifying high-risk individuals.
- The CHA2DS2-VASc-CF score is a valuable tool for interventional cardiologists to refine risk assessment and guide patient management after AMI.
Abstract:
The present study aimed to determine the long-term prognostic validity of the CHA2DS2-VASc score in patients with acute myocardial infarction (AMI). In addition, we formulated a novel scoring system, the CHA2DS2-VASc-CF (which includes cigarette smoking and a family history of coronary artery disease as risk factors). This study included 4373 consecutive patients with AMI who presented to the emergency department of our hospital and underwent cardiac catheterization procedures between December 2009 and September 2016. Among these patients, 1427 were diagnosed with ST elevation myocardial infarction (STEMI) and 2946 were diagnosed with non-STEMI. The study included 4373 patients. The study population was divided into 2 groups according to the occurrence of cardiovascular death during the follow-up period. Multivariate logistic regression analysis showed that the CHA2DS2-VASc-CF score, CHA2DS2-VASc score, major adverse cardiac events, current cigarette smoking, older age, hypertension, and family history of coronary artery disease were significantly higher, and that the left ventricular ejection fraction and glomerular filtration rate were significantly lower in the cardiovascular death (+) group. Using a cutoff score of >3 for the CHA2DS2-VASc-CF score, long-term cardiovascular death was predicted with a sensitivity of 78.4% and specificity of 76.4%. The CHA2DS2-VASc-CF score is suitable for use in all patients with AMI, regardless of the type of treatment, presence of atrial fibrillation, and type of AMI. This risk score, which is easy to calculate, provides important prognostic data. In the future, we think that interventional cardiologists will be able to use this novel scoring system to identify patients with a high risk of long-term cardiovascular death.
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