Cardiology Department, Hospital Universitario La Princesa, Madrid, Spain.
Cardiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
Int J Clin Pract. 2021 Jun;75(6):e14082. doi: 10.1111/ijcp.14082. Epub 2021 Mar 17.
CHA DS -VASc Score is widely used to predict thromboembolic risk in patients with Atrial Fibrillation (AF). We sought to study if this score predicts outcomes in elderly patients with Non-ST segment Elevation Acute Coronary Syndromes (NSTEACS).
The multicenter LONGEVO-SCA prospective registry included 532 unselected patients with NSTEACS aged ≥80 years. Data to calculate CHA DS -VASc Score were available in 523 patients (98.3%). They were classified according to CHA DS -VASc Score: group 1 (score ≤ 4), and 2 (5-9). We studied outcomes in terms of mortality or readmission at 6 months follow-up.
A total of 266 patients (51%) had a high CHA DS -VASc Score (group 2). They were more often women, with more cardiovascular risk factors, such as hypertension or diabetes mellitus, and history of previous stroke and cardiovascular disease and heart failure (all, P = .001). Geriatric syndromes (Barthel Index, Lawton Brody, cognitive impairment, and frailty) and Charlson Index were worse in this group (all, P = .001). They had poorer clinical status on admission, with worse Killip class and lower left ventricle ejection fraction (all, P = .001), and developed new-onset AF more often during admission (12.4% vs. 6.6%, P = .024). At six months follow-up, patients in group 2 had higher reinfarction, all-cause mortality, and mortality or readmission rates. A CHA DS -VASc Score > 4 was associated with mortality or readmission at 6 months (HR 2.07, P < .001). However, after adjusting for potential confounders, this last association was not significant (P = .175).
A CHA DS -VASc Score > 4 is present in half of octogenarians with NSTEACS and is associated with poorer outcomes. However, it is not an independent predictor of events and should not replace recommended tools for risk prediction in this setting.
CHA2DS2-VASc 评分广泛用于预测心房颤动（AF）患者的血栓栓塞风险。我们旨在研究该评分是否可预测非 ST 段抬高型急性冠脉综合征（NSTEACS）老年患者的结局。
多中心 LONGEVO-SCA 前瞻性注册研究纳入了 532 例年龄≥80 岁的非 ST 段抬高型急性冠脉综合征（NSTEACS）未入选患者。523 例（98.3%）患者可获得计算 CHA2DS2-VASc 评分的数据。根据 CHA2DS2-VASc 评分对患者进行分组：第 1 组（评分≤4 分）和第 2 组（5-9 分）。我们研究了 6 个月随访时的死亡率或再入院情况。
共 266 例（51%）患者 CHA2DS2-VASc 评分较高（第 2 组）。这些患者更多为女性，有更多心血管危险因素，如高血压或糖尿病，以及既往卒中史、心血管疾病和心力衰竭史（均 P<.001）。该组患者有更差的老年综合征（巴氏指数、罗迪 Brody 指数、认知障碍和衰弱）和 Charlson 指数（均 P<.001）。他们入院时临床状况较差，Killip 分级更差，左心室射血分数更低（均 P<.001），入院期间更常发生新发房颤（12.4%比 6.6%，P=.024）。6 个月随访时，第 2 组患者再发心梗、全因死亡率和死亡率或再入院率更高。CHA2DS2-VASc 评分>4 与 6 个月时的死亡率或再入院相关（HR 2.07，P<.001）。然而，在调整了潜在混杂因素后，这种关联不再具有统计学意义（P=.175）。
一半 80 岁以上 NSTEACS 患者的 CHA2DS2-VASc 评分>4，且与较差的结局相关。然而，它并不是该人群事件的独立预测因素，不应该替代推荐的风险预测工具。
