CHA2DS2-VASc Score Predicts Prognosis in Patients with Acute Coronary Syndrome without Atrial Fibrillation Undergoing Percutaneous Coronary Intervention.

Abstract

Purpose: To evaluate the prognostic value of the CHA₂DS₂-VASc score for 12-month major adverse cardiovascular events (MACE) in Chinese patients with acute coronary syndrome (ACS) without atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI).

Patients and methods: This retrospective study included 992 consecutive ACS patients without AF who underwent PCI from January 2019 to December 2022. Patients were stratified into low- (0-1), moderate- (2), and high-risk (>2) groups based on the CHA₂DS₂-VASc score. The primary endpoint was MACE, defined as a composite of all-cause mortality, non-fatal myocardial infarction, and non-fatal stroke. Multivariate Cox regression was used to evaluate the association between risk groups and outcomes.

Results: During the 12-month follow-up, MACE occurred in 12.7%, 21.4%, and 28.8% of the low-, moderate-, and high-risk groups, respectively (P<0.01). After adjusting for confounders, the CHA₂DS₂-VASc score remained independently associated with MACE (HR=2.27, 95% CI: 1.34-3.86 for moderate risk; HR=3.83, 95% CI: 1.90-7.69 for high risk; both P<0.01).

Conclusion: The CHA₂DS₂-VASc score independently predicts 12-month MACE in non-AF ACS patients after PCI, with risks 2.27-fold higher in moderate-risk and 3.83-fold higher in high-risk patients compared with low-risk patients. This simple, readily available tool may help identify patients at higher risk for MACE and inform secondary prevention strategies.