Cardiovascular Medicine Department, Assiut University Heart Hospital, Assiut University, Assiut, 71526, Egypt.
Department of Cardiology, Assiut Police Hospital, Assiut, 71514, Egypt.
BMC Cardiovasc Disord. 2024 May 21;24(1):263. doi: 10.1186/s12872-024-03929-5.
Risk stratification assessment of patients with non-ST elevation acute coronary syndrome (NSTE ACS) plays an important role in optimal management and defines the patient's prognosis. This study aimed to evaluate the ability of CHADS-VASc-HSF score (comprising of the components of the CHADS-VASc score with a male instead of female sex category, hyperlipidemia, smoking, and family history of coronary artery disease respectively) to predict the severity and complexity of CAD and its efficacy in stratification for major adverse cardiovascular events (MACE) in patients with NSTE ACS without known atrial fibrillation.
This study included 200 patients (males 72.5%, mean age 55.8 ± 10.1 years) who were admitted with NSTE ACS. CHADS-VASC-HSF score was calculated on admission. Patients were classified into three groups according to their CHADS-VASC-HSF score: low score group (< 2; 29 patients), intermediate score group (2-4; 83 patients), and high score group (≥ 5; 88 patients). Coronary angiography was conducted and the Syntax score (SS) was calculated. Clinical follow-up at 6 months of admission for the development of MACE was recorded.
SS was significantly high in the high CHADS-VASc-HSF score group compared with low and intermediate score groups. CHADS-VASc-HSF score had a significant positive strong correlation with syntax score (r = 0.64, P < 0.001). Smoking, vascular disease, hyperlipidemia, and CHADS-VASc-HSF score were independent predictors of high SS. For the prediction of severe and complex CAD, CHADS-VASc-HSF score had a good predictive power at a cut-off value ≥ 5 with a sensitivity of 86% and specificity of 65%. Hypertension, vascular disease, high SS, and CHADS-VASc-HSF score were independent predictors of MACE. CHADS-VASC-HSF score ≥ 4 was identified as an effective cut-off point for the development of MACE with 94% sensitivity and 70% specificity.
CHADS-VASC-HSF score is proposed to be a simple bedside score that could be used for the prediction of the severity and complexity of CAD as well as a risk stratification tool for the development of MACE in NSTE ACS patients.
非 ST 段抬高型急性冠状动脉综合征（NSTE ACS）患者的风险分层评估在优化管理和确定患者预后方面发挥着重要作用。本研究旨在评估 CHADS-VASc-HSF 评分（包含 CHADS-VASc 评分的组成部分，分别为男性而非女性性别、高脂血症、吸烟和冠心病家族史）预测 CAD 严重程度和复杂性的能力，并评估其在预测无已知心房颤动的 NSTE ACS 患者主要不良心血管事件（MACE）中的分层作用。
本研究纳入 200 例（男性 72.5%，平均年龄 55.8±10.1 岁）因 NSTE ACS 入院的患者。入院时计算 CHADS-VASC-HSF 评分。根据 CHADS-VASC-HSF 评分将患者分为三组：低评分组（<2；29 例）、中评分组（2-4；83 例）和高评分组（≥5；88 例）。行冠状动脉造影检查并计算Syntax 评分（SS）。记录入院后 6 个月时 MACE 的发生情况。
高 CHADS-VASc-HSF 评分组的 SS 明显高于低评分组和中评分组。CHADS-VASc-HSF 评分与 Syntax 评分呈显著正强相关（r=0.64，P<0.001）。吸烟、血管疾病、高脂血症和 CHADS-VASc-HSF 评分是 SS 高的独立预测因素。对于严重和复杂 CAD 的预测，CHADS-VASc-HSF 评分在截断值≥5 时具有良好的预测能力，其敏感性为 86%，特异性为 65%。高血压、血管疾病、高 SS 和 CHADS-VASc-HSF 评分是 MACE 的独立预测因素。CHADS-VASC-HSF 评分≥4 是发生 MACE 的有效截断点，其敏感性为 94%，特异性为 70%。
CHADS-VASC-HSF 评分是一种简单的床边评分，可用于预测 NSTE ACS 患者 CAD 的严重程度和复杂性，以及预测 MACE 的风险分层工具。
