The Predictive Value of CHA2DS2-VASc Score on Major Adverse Cardiovascular Events in Patients with Three Vessels or Left Main Diseases of Coronary Heart Disease

Abstract

Background SYNTAX score is the most common system for predicting the prognosis of patients with coronary heart disease based on coronary anatomy and lesions, and an evaluation method based on general clinical data is needed to improve the effectiveness of prediction. Objective To investigate the relationship between CHA2DS2-VASc scores and major adverse cardiovascular events in patients with three-vessel disease (TVD) or left main coronary artery disease (LMD) . Methods A total of 630 TVD/LMD patients were enrolled, and 276 patients were divided into the mild lesion group (0—22 points), 249 cases in the moderate lesion group (23—32 points) and 105 cases in the severe lesion group (≥33 points) according to SYNTAX score. Pearson correlation analysis and partial correlation analysis were used to explore the correlation between quantitative data, and univariate and multivariate Logistic regression analysis were used to investigate whether CHA2DS2-VASc and SYNTAX scores were risk factors for the incidence of MACEs within 3 years. The receiver operating characteristic (ROC) curve was plotted to evaluate the CHA2DS2-VASc score in predicting the occurrence of MACEs within 3 years. The ROC curves for predicting MACEs of CHA2DS2-VASc score, SYNTAX score, and the combination of the two scoring systems were compared using the Delong method. Results There were statistically significant differences in age, congestive heart failure, eGFR, LVEF, SYNTAX score, CHA2DS2-VASc score, MACEs within 3 years, death and non-fatal myocardial infarction among the groups with diferent degree of coronary stenosis (P<0.05), and CHA2DS2-VASc score was positively correlated with SYNTAX score (r=0.109, P=0.003). Multivariate Logistic regression analysis showed that hypertension〔OR=1.753, 95%CI (1.047, 2.938) 〕, LVEF 〔OR=0.962, 95%CI (0.942, 0.982) 〕, SYNTAX score 〔OR=1.028, 95%CI (1.002, 1.055) 〕, and CHA2DS2-VASc score 〔OR=1.210, 95%CI (1.070, 1.369) 〕 were independent influencing factors of MACEs of TVD/LMD patients within 3 years (P<0.05). ROC curve analysis showed that AUC of SYNTAX score predicting MACEs is 0.638, and AUC of CHA2DS2-VASc score predicting MACEs is 0.619. The AUC of combined SYNTAX and CHA2DS2-VASc score predicting MACEs was 0.685. The AUC difference between SYNTAX and CHA2DS2-VASc score was 0.019 (P=0.587) by Delong method, indicating that both SYNTAX and CHA2DS2-VASc scores had a predictive effect on MACEs, but the AUC difference was not statistically significant. The AUC difference between the combined two kind of score and SYNTAX score alone was 0.046 9 (P=0.046), and the AUC difference between the combined two kind of scores and CHA2DS2-VASc score oalone was 0.065 9 (P=0.043) . Conclusion The CHA2DS2-VASc score can be used to predict coronary artery severity and MACEs within 3 years in patients with three-vessel disease/left main coronary artery disease. Combined CHA2DS2-VASc and SYNTAX scoring system can effectively improved the predictive value of MACEs within 3 years.

Keywords

• coronary artery disease|cha2ds2-vasc score|syntax score|triple-vessel diseases|left main disease|predictive value