Study on the predictive ability of emergency CHADS score and CHADS-VASc score for coronary artery disease and prognosis in patients with acute ST-segment elevation myocardial infarction.

BACKGROUND

Acute ST-segment elevation myocardial infarction (STEMI) has a high morbidity and mortality rate. The congestive heart failure, hypertension, age, diabetes, previous stroke/transient ischemic attack (2 points) (CHADS) and CHADS score with 2 points assigned for age >75 years-vascular disease (CHADS-VASc) scores are widely used for risk stratification management of non-valvular atrial fibrillation stroke and have high prognostic value in cardiovascular disease. This study aims to investigate the predictive value of the emergency CHADS and CHADS-VASc score on coronary artery lesions and prognosis in patients with acute STEMI.

METHODS

A total of 524 patients with STEMI from May 2018 to October 2021 were selected for emergency CHADS and CHADS-VASc. Clinical data and laboratory indicators were collected. Patients were evaluated for coronary artery disease (CAD) and prognosis. Logistic regression and the receiver operating characteristic (ROC) curve were used to analyze the data.

RESULTS

In severe group, CysC levels, CHADS, CHADS-VASc score and the proportion of diabetes, stroke or transient ischemic attack (TIA), congestive heart failure, smoking history, Killip class ≥2 was higher than that in mild and moderate group. In poor prognosis group, levels of serum creatinine (Crea), CysC, hemoglobin (Hb), CHADS, CHADS-VASc score and the proportion of hypertension, diabetes, stroke or TIA, congestive heart failure, smoking history, and Killip class ≥2 was higher than that in good prognosis group. Diabetes (OR, 3.678; 95% CI: 2.876-5.872, 0.008), CHADS (OR, 3.829; 95% CI: 2.310-5.832, 0.003) and CHADS-VASc score (OR, 4.671; 95% CI: 3.125-6.187, 0.000) were independent risk factors for the severity of CAD (P<0.05). Diabetes (OR, 3.287; 95% CI: 2.231-5.123, 0.012), Killip class ≥2 (OR, 2.212; 95% CI: 1.023-2.987, 0.045), LVEF (OR, 3.110; 95% CI: 2.124-5.031, 0.023), CHADS (OR, 3.228; 95% CI: 2.133-5.886, 0.005) and CHADS-VASc score (OR, 3.988; 95% CI: 2.987-5.873, 0.001) were independent risk factors for prognosis of acute STEMI patients. Area under curve (AUC) value of CHADS-VASc score in evaluating CAD and prognosis was 0.947, 0.931, higher than that of the CHADS score (0.836, 0.812) (P<0.05).

CONCLUSIONS

Multiple factors jointly affect the severity and prognosis of CAD in patients with acute STEMI. The CHADS-VASc score is better than the CHADS score in predicting the severity of coronary artery lesions and prognosis of patients, providing theoretical support for clinical practice.