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Int J Cardiol. 2015 Nov 15;199:319-25. doi: 10.1016/j.ijcard.2015.07.064. Epub 2015 Jul 26.

Predictive accuracy of CHA2DS2-VASc and HAS-BLED scores in patients without atrial fibrillation undergoing percutaneous coronary intervention and discharged on dual antiplatelet therapy.

Author information

1
University of Catania, Ferrarotto Hospital, Catania, Italy. Electronic address: dcapodanno@gmail.com.
2
Papa Giovanni XXIII Hospital, Bergamo, Italy.
3
Carlo Poma Hospital, Mantova, Italy.
4
University of Florida, College of Medicine-Jacksonville, Jacksonville, FL, USA.
5
University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom.

Abstract

BACKGROUND:

The CHA2DS2-VASc and HAS-BLED are well-validated stroke risk prediction scores for atrial fibrillation (AF), but their role in risk stratification of major adverse cardiac events (MACEs) and major bleeding for non-AF patients undergoing percutaneous coronary intervention (PCI) is unknown.

METHODS:

Consecutive patients without AF undergoing PCI at two Italian centers were analyzed with different measures of discrimination, net reclassification improvement and net prognostic benefit. MACE included all-cause death, myocardial infarction, destabilizing symptoms leading to hospitalization, and nonfatal stroke. Major bleeding was defined according to the TIMI classification.

RESULTS:

Of 1437 subjects undergoing PCI, 1330 (mean age 63.6±10.9years, 75.7% male) fulfilled the inclusion criteria. During 2.7±1.2years of follow-up representing 3539 patient-years at risk, 187 patients had a MACE (5.3%/year) and 48 had a major bleeding (1.4%/year). The cumulative incidences of MACE were significantly stratified by both high CHA2DS2-VASc (P=0.020) or HAS-BLED (P<0.001) scores, whereas major bleeding episodes were not. The CHA2DS2-VASc and the HAS-BLED scores had similar C-statistics for MACE (0.56 vs 0.60; P=0.52) and major bleeding (0.63 vs 0.60; P=0.63). Compared with CHA2DS2-VASc, the HAS-BLED score more accurately reclassified events and no events both for MACE (NRI 8.21%) and major bleeding (NRI 6.85%).

CONCLUSIONS:

In patients without AF undergoing PCI and discharged on dual antiplatelet therapy, the HAS-BLED score performed better than the CHA2DS2-VASc for the prediction of MACE. Although both scores predict MACE, their discrimination was modest. Conversely, both scores did not significantly predict major bleeding in non-AF patients undergoing PCI.

KEYWORDS:

CHA(2)DS(2)-VASc; HAS-BLED; PCI; Stents

PMID:
26241637
DOI:
10.1016/j.ijcard.2015.07.064
[Indexed for MEDLINE]

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