Prognostic Impacts of CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-HS Scores on Clinical Outcomes After Elective Drug-Eluting Stent Placement for De Novo Coronary Stenosis.

Circulation Reports Pub Date : 2023-03-15 eCollection Date: 2023-04-10 DOI:10.1253/circrep.CR-22-0120
Tomoaki Ukaji, Tetsuya Ishikawa, Hidehiko Nakamura, Yukiko Mizutani, Kouta Yamada, Masatoshi Shimura, Yuki Kondo, Yohei Tamura, Yuri Koshikawa, Itaru Hisauchi, Shiro Nakahara, Yuji Itabashi, Sayuki Kobayashi, Isao Taguchi
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Abstract

Background: The prognostic impact of CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-HS scores on clinical outcomes after drug-eluting stent (DES) placement has not been fully elucidated. Methods and Results: The present study was a retrospective, non-randomized, single-center, and lesion-based study. Target lesion failure (TLF), comprising cardiac death, non-fatal myocardial infarction, and target vessel revascularization, occurred in 7.1% of 872 consecutive de novo coronary lesions in 586 patients. These patients were electively and exclusively treated by DESs from January 2016 to January 2022 until July 2022 with a mean (±SD) observational interval of 411±438 days. Multivariate Cox proportional hazard analysis revealed that CHA2DS2-VASc-HS scores ≥7 (hazard ratio [HR] 1.800; 95% CI 1.06-3.05; P=0.029) was a significant predictor of cumulative TLF among 24 variables evaluated. CHADS2 scores ≥2 (HR 3.213; 95% CI 1.32-7.80; P=0.010) and CHA2DS2-VASc scores ≥5 (HR 1.980; 95% CI 1.10-3.55; P=0.022) were also significant in the multivariate analysis. Pairwise comparisons of receiver operating characteristic curves for CHADS2 score ≥2, CHA2DS2-VASc score ≥5, and CHA2DS2-VASc-HS score ≥7 showed they were equivalent in terms of predicting the incidence of TLF, with areas under the curve of 0.568, 0.575, and 0.573, respectively. Conclusions: All 3 cardiocerebrovascular thromboembolism risk scores were strong predictors of the incidence of cumulative mid-term TLF after elective DES placement, with cut-off values of 2, 5, and 7, respectively, and equivalent prognostic impacts.

Abstract Image

CHADS2、CHA2DS2-VASc 和 CHA2DS2-VASc-HS 评分对新发冠状动脉狭窄患者选择性药物洗脱支架置入术后临床预后的影响。
背景:CHADS2、CHA2DS2-VASc 和 CHA2DS2-VASc-HS 评分对药物洗脱支架(DES)置入后临床预后的影响尚未完全阐明。方法和结果:本研究是一项回顾性、非随机、单中心和基于病变的研究。在 586 名患者的 872 个连续新发冠状动脉病变中,7.1% 的患者发生了靶病变失败(TLF),包括心源性死亡、非致死性心肌梗死和靶血管血运重建。这些患者在2016年1月至2022年1月直至2022年7月期间选择性地全部接受了DES治疗,平均(±SD)观察间隔为411±438天。多变量Cox比例危险分析显示,在24个评估变量中,CHA2DS2-VASc-HS评分≥7(危险比[HR]1.800;95% CI 1.06-3.05;P=0.029)是累积TLF的重要预测因素。CHADS2 评分≥2(HR 3.213;95% CI 1.32-7.80;P=0.010)和 CHA2DS2-VASc 评分≥5(HR 1.980;95% CI 1.10-3.55;P=0.022)在多变量分析中也具有显著性。对CHADS2评分≥2分、CHA2DS2-VASc评分≥5分和CHA2DS2-VASc-HS评分≥7分的接收者操作特征曲线进行配对比较后发现,它们在预测TLF的发生率方面相当,曲线下面积分别为0.568、0.575和0.573。结论所有三种心脑血管血栓栓塞风险评分都能很好地预测择期置入DES后累积中期TLF的发生率,截止值分别为2、5和7,对预后的影响相当。
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