AUTHOR=Pang Hui , Zhu Xu , Cheang Iokfai , Zhang Haifeng , Zhou Yanli , Liao Shengen , Li Xinli 

TITLE=CHA2DS2-VASc score for in-hospital recurrence risk stratification in patients with myocardial infarction

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=9

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.925932

DOI=10.3389/fcvm.2022.925932

ISSN=2297-055X

ABSTRACT=<sec><title>Background</title><p>Using the CHA<sub>2</sub>DS<sub>2</sub>-VASc score to recognize the risk of stroke in patients with atrial fibrillation has been well-established. However, few studies have assessed whether the CHA<sub>2</sub>DS<sub>2</sub>-VASc score has a similar predictive value in recurrence after myocardial infarction (MI).</p></sec><sec><title>Methods</title><p>We conducted a retrospective observational cohort study of adult inpatients with MI. The CHA<sub>2</sub>DS<sub>2</sub>-VASc and modified CHA<sub>2</sub>DS<sub>2</sub>-VASc (MCHA<sub>2</sub>DS<sub>2</sub>-VASc) scores of all patients were calculated. The associations of both scores with recurrent MI were analyzed.</p></sec><sec><title>Results</title><p>A total of 6,700 patients with MI (60.0 ± 11.1 years, 77.2% men) were enrolled, and 759 (11.3%) presented a definite recurrence during hospitalization. After multivariable adjustment by logistic regression in patients with MI, the CHA<sub>2</sub>DS<sub>2</sub>-VASc and MCHA<sub>2</sub>DS<sub>2</sub>-VASc scores were independently associated with recurrence. The MCHA<sub>2</sub>DS<sub>2</sub>-VASc score showed a better predictive value for risk of recurrence than that of CHA<sub>2</sub>DS<sub>2</sub>-VASc in overall [area under the receiver operating characteristic curve (AUC) 0.757 vs. 0.676] or male patients (AUC 0.759 vs. 0.708). MCHA<sub>2</sub>DS<sub>2</sub>-VASc was superior to CHA<sub>2</sub>DS<sub>2</sub>-VASc for identifying “truly high-risk” patients with MI, regardless of overall patients or sex-specific subgroups. The two scores had a similar focus on the identification of “low-risk” patients in overall or women, but not in men.</p></sec><sec><title>Conclusion</title><p>The CHA<sub>2</sub>DS<sub>2</sub>-VASc and MCHA<sub>2</sub>DS<sub>2</sub>-VASc scores for predicting recurrence are validated in patients with MI. However, MCHA<sub>2</sub>DS<sub>2</sub>-VASc could be more helpful to secondary prevention than CHA<sub>2</sub>DS<sub>2</sub>-VASc after MI, especially in men. The superiority of MCHA<sub>2</sub>DS<sub>2</sub>-VASc compared with CHA<sub>2</sub>DS<sub>2</sub>-VASc in women is just more discriminatory for “truly high-risk” patients.</p></sec>