Relationship between CHA2DS2-VASc score, coronary artery disease severity, residual platelet reactivity and long-term clinical outcomes in patients with acute coronary syndrome

Abstract

Background: The CHA₂DS₂-VASc score predicts stroke risk in patients with atrial fibrillation, but recently has been reported to have a prognostic role even in patients with ACS. We sought to assess the ability of the CHA₂DS₂-VASc score to predict the severity of coronary artery disease, high residual platelet reactivity and long-term outcomes in patients with acute coronary syndrome (ACS).

Methods: Overall, 1729 consecutive patients with ACS undergoing invasive management were included in this prospective registry. We assessed platelet reactivity via light transmittance aggregometry after clopidogrel loading. Patients were divided according to the CHA₂DS₂-VASc score: group A = 0, B = 1, C = 2, D = 3, E = 4 and F ≥ 5.

Results: Patients with higher CHA₂DS₂-VASc score were more likely to have a higher rate of multivessel CAD (37%, 47%, 55%, 62%, 67 and 75% in Group A, B, C, D, E and F; p < 0.001); moreover, CHA₂DS₂-VASc score correlated linearly with residual platelet reactivity (R = 0.77; p < 0.001). At long-term follow-up, estimated adverse event rates (MACCE: cardiac death, MI, stroke or any urgent coronary revascularization) were 3%, 8%, 10%, 14%, 19% and 24% in group A, B, C, D, E and F; p < 0.001. Multivariable analysis demonstrated CHA₂DS₂-VASc to be an independent predictor of severity of coronary artery disease, of high residual platelet reactivity and of MACCE.

Conclusions: In a cohort of patients with ACS, CHA₂DS₂-VASc score correlated with coronary disease severity and residual platelet reactivity, and therefore it predicted the risk of long-term adverse events.

Keywords: Acute coronary syndrome; CHA(2)DS(2)-VASc score; Coronary artery disease; Major cardiocerebrovascular events; PCI; Platelet reactivity.