Investigation of the relationship between CHA2DS2-VASc score and coronary complexity in atherosclerotic coronary artery disease.

Year 2021, Volume: 7 Issue: 1, 1 - 17, 30.09.2021

Ömer Faruk Çırakoğlu , Şükrü Çelik

Abstract

Aim:The CHA2DS2-VASc score is a clinical predictor of the risk of stroke in patients with atrial fibrillation. In this study, we aimed to investigate the relationship between CHA2DS2-VASc score and SYNTAX score (SS) in patients who were diagnosed as stable angina pectoris (SAP) and acute coronary syndrome (ACS).
Methods and resuts:Total 488 patients who were diagnosed as SAP and ACS between January 2014 and February 2015 were enrolled. Coronary angiography was performed and SS was calculated. The risk factors of CAD and demographic features were recorded and CHA2DS2-VASc scores were calculated. Subsequently,statistical analysis was performed between the scores. The relationship between SS and age,hypertension, DM, EF and CHA2DS2-VASc score was investigated with nonparametric correlation tests. Positive correlation was determined between age and SS (r=,154,p<0,001). A positive correlation between SS and hypertension was statistically shown (r=,387,p<0,001). A positive correlation between the SS and presence DM (r=,220,p<0,001) was proved. A negative correlation was found between EF and SS (r=-,429,p<0,001). The relationship between CHA2DS2-VASc score and SS, which is the main purpose of the study was found to have a positive correlation (r=,379,p<0,001). The differences of median score between SAP and ACS groups were shown to be statistically significant (p<0,001).Likewise, the average score of SS between groups was found to be statistically significant (p<0,001).
Conclusion:The relationship between CHA2DS2-VASc score and SS is shown in the spectrum of CAD including SAP and ACS. It has been demonstrated that the CHA2DS2-VASc score is a cheap, simple, practical and fast algorithm that correlates with coronary complexity.

Keywords

CHA2DS2-VASc score, SYNTAX score, stable angina pectoris, acute coronary syndrome, coronary lesion complexity.

Supporting Institution

NONE

Aterosklerotik koroner arter hastalığında CHA2DS2-VASc skoruyla koroner kompleksitenin ilişkisinin araştırılması

Abstract

Amaç: Atriyal fibrilasyonda tromboembolik inme risk tayininde kullanılan ve aterosklerotik koroner arter hastalığı (KAH) major risk faktörlerinin birçoğunu içeren CHA2DS2-VASc skorunun, koroner kompleksitenin ciddiyetini ve seviyesini belirlemede önemli veriler sunan SYNTAX skoru (SS) ile olan ilişkisini araştırmak.
Gereç ve yöntemler: Çalışmamıza Ocak 2014 –Şubat 2015 tarihleri arasında akut koroner sendrom (AKS) ve stabil angina pektoris (SAP) tanılarıyla koroner anjiografileri yapılan 488 hasta alındı, SS hesaplandı. KAH için risk faktörleri, demografik özellikleri kayıt edildi ve CHA2DS2-VASc skorları hesaplandı. Sonrasında SAP ve AKS hastaları için belirtilen skorlar arasında istatiksel analizler yapıldı.
Bulgular: SAP ve AKS tanılı tüm hastalarda SS ile yaş, hipertansiyon, diyabetes mellitus (DM), ejeksiyon fraksiyonu (EF) ve CHA2DS2-VASc skoru arasındaki ilişki nonparametrik korelasyon testleriyle araştırıldı. SS ile yaş arasında pozitif düzeyde korelasyon tespit edildi (r=,154, p<0,001). Hipertansiyon varlığı ile SS arasında pozitif yönde korelasyon olduğu istatiksel olarak gösterildi (r=,387, p<0,001). DM varlığı ile SS arasında da pozitif korelasyon olduğu görüldü (r=,220, p<0,001). EF ile SS arasında da negatif düzeyde korelasyon saptandı (r=-,429, p<0,001). Çalışmamızın temel noktası olan CHA2DS2-VASc skoru ile SS arasındaki ilişkinin de pozitif korelasyon şeklinde olduğu saptandı (r=,379, p<0,001). SAP ile AKS grupları arasında CHA2DS2-VASc skorunun ortanca değerinin farklılığının istatiksel olarak anlamlı olduğu gösterildi (p<0,001). Yine gruplar arasında SS ortalamasının istatiksel olarak anlamlı derecede farklı olduğu görüldü (p<0,001)
Sonuç: SAP ve AKS'yi içeren KAH spektrumunda CHA2DS2-VASc skorunun SS ile ilişkisini gösterilmiştir. CHA2DS2-VASc skorunun koroner kompleksiteyle korelasyon gösteren, ucuz, basit, pratik ve hızlı bir algoritma olduğu ortaya konulmuştur.

Keywords

CHA2DS2-VASc skoru, SYNTAX skoru, stabil angina pektoris, akut koroner sendrom, koroner lezyon kompleksitesi

References

• 1. Sanchis-Gomar F, Perez-Quilis C, Leischik R, Lucia A. Epidemiology of coronary heart disease and acute coronary syndrome. Ann Transl Med. 2016;4(13):256.
• 2. Virmani R, Burke AP, Farb A, Kolodgie FD. Pathology of the vulnerable plaque. J Am Coll Cardiol 2006;47:C13-8.
• 3. O'Gara PT, Kushner FG, Ascheim DD, Casey DE, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013;127:e362-e425.
• 4. Amsterdam EA, Wenger NK, Brindis RG, Casey DE, et al. 2014 AHA/ACC Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014;64:e139-e228.
• 5. Nelson RH. Hyperlipidemia as a risk factor for cardiovascular disease. Prim Care. 2013; 40(1): 195–211.
• 6. Lip GY, Nieuwlaat R, Pisters R, Lane DA, et al. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey on atrial fibrillation. Chest 2010;137(2):263–272.
• 7. Cetin M, Cakici M, Zencir C, Tasolar H, et al. Prediction of coronary artery disease severity using CHADS2 and CHA2DS2-VASc scores and a newly defined CHA2DS2-VASc-HS score. Am J Cardiol. 2014;113(6):950–956.
• 8. Gensini GG. A more meaningful scoring system for determining the severity of coronary heart disease. Am J Cardiol 1983;51:606.
• 9. Uehara M, Funabashi N, Takaoka H, Ozawa K, et al. CHA2DS2-VASc score is a useful-predictor of not prognosis but coronary-arteriosclerosis in chronic atrial-fibrillation compared with CHADS2 score: a two-center study of 320-slice CT, part 2. International journal of cardiology, 2014:177(2), 368-373.
• 10. Wright RS , Anderson JL , Adams CD , Bridges CR, et al. 2011 ACCF/AHA focused update incorporated into the ACC/AHA 2007 Guidelines for the Management of Patients with Unstable Angina/Non-ST-Elevation Myocardial Infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines . J Am Coll Cardiol . 2011;57(19):e215 -367.
• 11. National Clinical Guideline Centre (UK). Unstable Angina and NSTEMI: The Early Management of Unstable Angina and Non-ST-Segment-Elevation Myocardial Infarction. London: Royal College of Physicians (UK); 2010. PMID: 21977549.
• 12. Eagle KA, Lim MJ, Dabbous OH, Pieper KP, et al ; GRACE Investigators . A validated prediction model for all forms of acute coronary syndrome: estimating the risk of 6-month postdischarge death in an international registry. JAMA. 2004;291(22):2727-2733).
• 13. Poçi D, Hartford M, Karlsson T, Herlitz J, et al. Role of the CHADS 2 score in acute coronary syndromes: risk of subsequent death or stroke in patients with and without atrial fibrillation . Chest . 2012;141(6):1431-1440.
• 14. Jeong YW, Jeong MH2, Kim SS, Rhew SH, et al. CHA2DS2-VASc scoring system as an initial method for screening high-risk patients in acute myocardial infarction. Int J Cardiol 2014;174:777–780.
• 15. Ford ES, Giles WH, Mokdad AH. The distribution of 10-year risk for coronary heart disease among US adults: findings from the National Health and Nutrition Examination Survey III. J Am Coll Cardiol 2004;43:1791-1796.
• 16. Eberly LE, Neaton JD, Thomas AJ, Dai Y, et al. Multiple Risk Factor Intervention Trial Research Group. Multiple-stage screening and mortality in the Multiple Risk Factor Intervention Trial. Clin Trials 2004;1:148-161.