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Thromb Res. 2014 Apr;133(4):560-6. doi: 10.1016/j.thromres.2014.01.007. Epub 2014 Jan 11.

CHADS2, CHA2DS2-VASc and HAS-BLED as predictors of outcome in patients with atrial fibrillation undergoing percutaneous coronary intervention.

Author information

  • 1Hemostasis laboratory, Finnish Red Cross Blood Service, Helsinki, Finland.
  • 2Heart Center, Turku University Hospital and University of Turku, Turku, Finland.
  • 3Medical Faculty, Martin Luther University Halle-Wittenberg, Germany.
  • 4Division of Cardiology, Laboratory of Interventional Cardiology, Ospedale Maggiore, Bologna, Italy.
  • 5Heart Center, Satakunta Central Hospital, Pori, Finland.
  • 6Department of Cardiology, Central Finland Central Hospital, Jyväskylä, Finland.
  • 7Department of Medicine, Oulu University Hospital, Oulu, Finland.
  • 8University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom.
  • 9Heart Center, Turku University Hospital and University of Turku, Turku, Finland. Electronic address: juhani.airaksinen@tyks.fi.

Abstract

INTRODUCTION:

CHADS2 and CHA2DS2-VASc scores are used to estimate thromboembolic risk in atrial fibrillation (AF). HAS-BLED is recommended for bleeding risk prediction. Their value in predicting the outcome of AF patients after percutaneous coronary intervention (PCI) is unknown. Thus, our aim was to assess whether these simple risk scores are useful in predicting outcome in these patients.

MATERIALS AND METHODS:

AFCAS is an observational, multicenter, prospective registry including patients (n=929) with AF referred for PCI. Primary study endpoints were 1) all cause mortality; 2) major adverse events (all-cause mortality, myocardial infarction, repeat revascularization, stent thrombosis, transient ischemic attack, stroke or other arterial thromboembolism; MACCE); and 3) bleeding at 12 months follow-up. CHADS2 and CHA2DS2-VASc scores and a modified HAS-BLED (mHAS-BLED) score (omitting labile INR and liver function) were calculated.

RESULTS:

Patients were distributed as follows: CHADS2 low 29.5%, intermediate 55.2%, high 15.3%; CHA2DS2-VASc low 9.6%, intermediate 46.0%, high 44.5%. A high CHA2DS2-VASc score was predictive of all-cause mortality (p=0.02), whereas CHADS2 was not. High CHA2DS2-VASc score predicted MACCE (HR 2.24, 95%CI 1.21-4.17, p=0.01), as did a high CHADS2 score (HR 1.60, 95%CI 1.05-2.45, p=0.029). Their predictive performance was only modest (C indexes 0.56-0.57). CHADS2 or CHA2DS2-VASc scores were not associated with bleeding. High mHAS-BLED scores (≥3) were not associated with any of the study outcomes.

CONCLUSIONS:

High CHA2DS2-VASc score was the best predictor of thrombotic outcomes after PCI in a high risk AF population. High mHAS-BLED score was not predictive of bleeding events. More accurate, simple risk scores are needed.

Copyright © 2014 Elsevier Ltd. All rights reserved.

KEYWORDS:

Atrial fibrillation; CHA(2)DS(2)-VASc; CHADS(2); HAS-BLED; PCI; Risk scoring schemes

PMID:
24461143
[PubMed - indexed for MEDLINE]
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