The Predictive Value of CHADS-VASc Score on In-Hospital Death and Adverse Periprocedural Events Among Patients With the Acute Coronary Syndrome and Atrial Fibrillation Who Undergo Percutaneous Coronary Intervention: A 10-Year National Inpatient Sample (NIS) Analysis.

BACKGROUND

The predictive value of CHADS-VASc score regarding the in-hospital death and periprocedural adverse events following percutaneous coronary intervention (PCI) among patients with acute coronary syndrome (ACS) and concomitant atrial fibrillation (AF) is not established.

METHODS

We retrospectively analyzed data of patients with the in-hospital and primary diagnosis of ACS, with concomitant AF, who underwent PCI during the 2004-2014 period from the US National Inpatient Sample database. A CHADS-VASc score was incorporated into multiple covariate-adjusted logistic regression analyses to determine its independent impact on designated outcomes.

RESULTS

A total of 283,890 patients hospitalized with the primary diagnosis of ACS who underwent PCI and had an AF on record were included in the analysis. The average reported prevalence of AF in the whole cohort of ACS patients was 10.0% with a significant increasing trend during the observed 10-year period (p < .001). The average age of the cohort was 72.1 ± 11 years, 63.4% were male while the median CHADS-VASc score was 3 (IQR 2-4). Following adjustment for baseline covariates, incremental increase in CHADS-VASc score was independently associated with an increased odds of in-hospital death (OR 1.20, CI 95% 1.18-1.22), periprocedural vascular injury (OR 1.18, 95% CI 1.17-1.20), bleeding (OR 1.17, 95% CI 1.16-1.18), stroke/transient ischemic attack (OR 1.17, 95% CI 1.15-1.19), and acute kidney injury (OR 1.05, 95% CI 1.04-1.06).

CONCLUSIONS

The CHADS-VASc score provides important prognostic information in ACS patients undergoing PCI. It is independently associated with in-hospital death and adverse periprocedural events following PCI in patients presenting with ACS and concomitant AF.