Clinical Application of CHADS-VASc versus GRACE Scores for Assessing the Risk of Long-term Ischemic Events in Atrial Fibrillation and Acute Coronary Syndrome or PCI.

BACKGROUND

Early risk stratification of patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI) has relevant implication for individualized management strategies. The -VASc and GRACE ACS risk model are well-established risk stratification systems. We aimed to assess their prognostic performance in AF patients with ACS or PCI.

METHODS

Consecutive patients with AF and ACS or referred for PCI were prospectively recruited and followed up for 3 years. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCEs), including cardiovascular mortality, myocardial infarction, ischemic stroke, systemic embolism and ischemia-driven revascularization.

RESULTS

Higher -VASc (HR [hazard ratio] 1.184, 95% CI 1.091-1.284) and GRACE at discharge score (HR 1.009, 95% CI 1.004-1.014) were independently associated with increased risk of MACCEs. The -VASc (c-statistics: 0.677) and GRACE at discharge (c-statistics: 0.699) demonstrated comparable discriminative capacity for MACCEs ( = 0.281) while GRACE at admission provided relatively lower discrimination (c-statistics: 0.629, vs. -VASc = 0.041). For predicting all-cause mortality, three models displayed good discriminative capacity (c-statistics: 0.750 for -VASc, 0.775 for GRACE at admission, 0.846 for GRACE at discharge). A significant discrimination improvement of GRACE at discharge compared to -VASc was detected (NRI = 45.13%).

CONCLUSIONS

In the setting of coexistence of AF and ACS or PCI, -VASc and GRACE at discharge score were independently associated with an increased risk of MACCEs. The GRACE at discharge performed better in predicting all-cause mortality.