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The Association Between High CHA2DS2-VASc Scores and Short and Long-Term Mortality for Coronary Care Unit Patients
Long Cheng1, Sheng Kang2, Li Lin2
1Department of Cardiovascular Medicine, Shanghai Pudong New Area Gongli Hospital, Shanghai, P.R. China.
Insights
A high CHA2DS2-VASc score is linked to increased mortality in coronary care unit (CCU) patients. This finding highlights the score's importance in predicting short-term and long-term survival for CCU admissions.
Area of Science:
- Cardiology
- Intensive Care Medicine
- Public Health
Background:
- The CHA2DS2-VASc score is recognized for its prognostic value in cardiovascular diseases.
- Understanding its association with mortality in coronary care unit (CCU) patients is crucial for risk stratification.
Purpose of the Study:
- To investigate the relationship between the CHA2DS2-VASc score and all-cause mortality in CCU patients.
- To assess the score's predictive power for 30-day, in-hospital, 1-year, and 5-year mortality.
Main Methods:
- Utilized the Medical Information Mart for Intensive Care (MIMIC) III database for CCU patient data.
- Employed propensity score matching (PSM) to balance baseline characteristics between low (CHA2DS2-VASc score 0-3) and intermediate/high risk (score 4-9) groups.
- Applied restricted cubic splines to analyze the association of various biomarkers with 30-day mortality post-PSM.
Main Results:
- Patients with intermediate/high CHA2DS2-VASc scores exhibited significantly higher 30-day, 1-year, and 5-year mortality rates compared to low-risk patients.
- Hazard ratios indicated increased mortality risk across all assessed time points for higher scores.
- Nonlinear relationships were observed between 30-day mortality and specific biomarkers like platelets, hemoglobin, white blood cell count, glucose, potassium, and sodium.
Conclusions:
- Elevated CHA2DS2-VASc scores independently predict increased 30-day, 1-year, and 5-year mortality in CCU patients.
- The CHA2DS2-VASc score serves as a valuable prognostic tool for CCU populations.
- Further research can explore the impact of specific biomarkers on mortality within different CHA2DS2-VASc score strata.
Background:
The CHA2DS2-VASc score has been associated with the prognosis of cardiovascular diseases. This study aimed to explore the association between the CHA2DS2-VASc score and all-cause mortality in coronary care unit (CCU) patients.
Methods:
The study was based on the Medical Information Mart for Intensive Care (MIMIC) III database. CCU patients were divided into two groups according to CHA2DS2-VASc score: 0-3 (low risk)，4-9 (intermediate and high risk). The primary outcome was 30-day mortality, and the secondary endpoints included in-hospital, 1-year, and 5-year mortality. Propensity score matching (PSM) and sensitivity analyzes for the confounders were also performed. The restricted cubic splines flexibility model was used to demonstrate the relation between red blood cell volume distribution width (RDW), blood urea nitrogen (BUN), platelet, white blood cell (WBC), hemoglobin, phosphorus, glucose, potassium, sodium and 30-day mortality in the 0-3 score versus the 4-9 score groups after PSM.
Results:
Among 4491 eligible patients, 988 patients with low CHA2DS2-VASc scores and 988 patients with intermediate and high CHA2DS2-VASc scores had similar propensity scores and were included in the analyzes. In the survival analysis, the patients with intermediate and high CHA2DS2-VASc scores were associated with higher 30-day mortality [hazard ratio (HR): 1.11; 95% confidence interval (CI), 1.02-1.20, P = .014], 1-year mortality [HR: 1.13; 95%CI, 1.06-1.19, P < .001], and 5-year mortality [HR: 1.13; 95%CI, 1.07-1.18, P < .001]. The interaction for 30-day mortality among subgroups was not significant between the 0-3 score versus the 4-9 score groups. The restricted cubic splines for 30-day mortality demonstrated an L-shaped trajectory for platelets and hemoglobin, a J-shaped trajectory for WBC, glucose and potassium, and a U-shaped trajectory for sodium, respectively (all nonlinear P <.001).
Conclusions:
A high CHA2DS2-VASc score was an independent risk for 30-day, 1-year, and 5-year mortality for CCU patients.
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