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Association between R2CHA2DS2-VASc score and three-vessel coronary artery disease in a large population at high

Gabriella Pacilli1, Pamela Piscitelli1, Maria Maddalena D'Errico1

  • 1Units of Internal Medicine, Fondazione IRCCS Casa Sollievo Della Sofferenza, viale Cappuccini, 71013, San Giovanni Rotondo, Italy.

Internal and Emergency Medicine
|July 6, 2024
PubMed

Insights

The R2CHA2DS2-VASc score effectively predicts three-vessel coronary disease (3VD) in high-risk patients. Higher scores indicate a significantly increased risk of severe coronary artery disease.

Area of Science:

  • Cardiology
  • Nephrology

Background:

  • Coronary artery disease (CAD), especially three-vessel disease (3VD), is a leading cause of mortality.
  • Chronic kidney disease (CKD) is an independent risk factor for CAD.
  • The CHA2DS2-VASc score predicts cardiovascular events in high-risk populations.

Purpose of the Study:

  • To evaluate the association between the R2CHA2DS2-VASc score and 3VD in high-risk cardiovascular patients.
  • To determine if the modified score, incorporating estimated glomerular filtration rate (eGFR), improves 3VD risk prediction.

Main Methods:

  • A monocentric prospective study included 1017 patients undergoing coronary angiography.
  • The R2CHA2DS2-VASc score was calculated by adding 2 points to the CHA2DS2-VASc score for patients with eGFR < 60 ml/min/1.73m².
  • Significant coronary lesions were defined as ≥50% diameter reduction in major epicardial vessels.

Main Results:

  • Patients with 3VD had a significantly higher R2CHA2DS2-VASc score (4.20 ± 2.18) compared to those without 3VD (3.36 ± 2.06).
  • Each 1-point increase in the R2CHA2DS2-VASc score was associated with a 21% increased risk of 3VD (OR 1.21).
  • The prevalence of 3VD increased significantly across R2CHA2DS2-VASc tertiles, with the highest tertile showing more than double the risk of the lowest (OR 2.45).

Conclusions:

  • The R2CHA2DS2-VASc score is independently associated with 3VD in patients at high cardiovascular risk.
  • This modified score may serve as a valuable clinical tool for identifying patients at elevated risk for 3VD.
  • Integrating renal function into risk scores enhances prediction for complex cardiovascular conditions.

Keywords:
CHA2DS2-VAScCardiovascular riskChronic kidney diseaseR2CHA2DS2-VAScThree-vessel coronary artery disease

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