CHA2DS2-VASc and R2CHA2DS2-VASc scores predict mortality in high cardiovascular risk population

Abstract

Background: The CHA₂ DS₂ -VASc score, widely used to estimate cardioembolic risk in patients with atrial fibrillation (AF), appears to be useful also in predicting vascular adverse events and death in different sets of patients without AF. The R₂ CHA₂ DS₂ -VASc score, which includes renal impairment, allows a better prediction of death and thromboembolism in patients without AF. The aims of our study were to assess, in a large sample of patients at high cardiovascular (CV) risk, (i) the correlation between CHA₂ DS₂ -VASc and R₂ CHA₂ DS₂ -VASc with all-cause mortality, and (ii) to compare the performances of CHA₂ DS₂ -VASc and R₂ CHA₂ DS₂ -VASc in predicting all-cause mortality.

Methods: In this single-centre prospective observational study, conducted at the Research Hospital 'Casa Sollievo della Sofferenza' between June 2016 and December 2018, 1017 CV patients at high risk of undergoing coronary angiography were enrolled.

Results: CHA₂DS₂-VASc and R₂ CHA₂ DS₂ -VASc scores significantly associated with all-cause mortality. For each one-point increase in CHA₂ DS₂ -VASc or R₂ CHA₂ DS₂ -VASc scores, mortality increased by almost 1.5-fold. The R₂ CHA₂ DS₂ -VASc score (C-statistic = 0.71; 95% CI = 0.65-76) outperformed the CHA₂ DS₂ -VASc score (C-statistic = 0.66; 95% CI = 0.61-0.71) in predicting 4-year mortality (delta C-statistic = 0.05; 95% CI = 0.02-0.07). The better predictive ability of the R-CHA₂ DS₂ -VASc score was also demonstrated by an IDI = 0.027 (95% CI = 0.021-0.034, p < .00001) and a relative IDI = 62.8% (95% CI = 47.9%-81.3%, p < .00001). The R₂ CHA₂ DS₂ -VASc score correctly reclassified the patients with a NRI = 0.715 (95% = 0.544-0.940, p < .00001).

Conclusions: The CHA₂DS₂-VASc and R₂ CHA₂ DS₂ -VASc scores are useful predictors of all-cause mortality in subjects at high CV risk, with the R₂ CHA₂ DS₂ -VASc score being the best performer.

Keywords: CHA2DS2-VASc; GFR; R2CHA2DS2-VASc; cardiovascular risk; mortality.