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- Title
CHADS-VASc score is useful in predicting poor 12-month outcomes following myocardial infarction in diabetic patients without atrial fibrillation.
- Authors
Hudzik, Bartosz; Szkodziński, Janusz; Hawranek, Michal; Lekston, Andrzej; Poloński, Lech; Gąsior, Mariusz
- Abstract
Aims: TIMI risk score and GRACE risk model are widely available and accepted scores for risk assessment in STEMI patients and include predictors of poor outcomes. CHADS-VASc is a validated score for predicting embolic/stroke risk in patients with non-valvular atrial fibrillation. Its components contribute to the worse prognosis following myocardial infarction. The advantage of the CHADS-VASc score in comparison with other risk scores is that it provides a comprehensive, fast, and simple method for physicians in risk evaluation that requires no calculators or computers. Therefore, we have set out to examine the prognostic significance of CHADS-VASc score following STEMI in diabetic patients without AF. Methods: A total of 472 patients with diabetes mellitus and STEMI undergoing primary PCI were enrolled. Based on the estimated CHADS-VASc score, the study population was divided into three groups: group 1 ( N = 111) with a moderate CHADS-VASc score of 2 or 3; group 2 ( N = 257) with a high CHADS-VASc score of 4 or 5; and group 3 ( N = 104) with a very high CHADS-VASc score of 6 or higher. Results: In diabetic patients with STEMI, the median of CHADS-VASc score was 4 (interquartile range 3-5). In-hospital mortality rate was similar across three groups. CHADS-VASc score was not a risk factor of in-hospital mortality. ROC analysis revealed good diagnostic value of CHADS-VASc score in predicting long-term mortality (AUC 0.62 95 % CI 0.57-0.66 P = 0.0003) and stroke (AUC 0.75 95 % CI 0.71-0.79 P = 0.0003), but no value in predicting long-term myocardial infarction. CHADS-VASc score was an independent predictor of 12-month mortality and stroke. One-point increment in CHADS-VASc score was associated with an increase in the risk of 12-month death by 24 % and for 12-month stroke by 101 %. Conclusions: In diabetic patients with STEMI and no previous AF, median CHADS-VASc score was high (4 points) and predicted 12-month death and stroke. However, it failed to predict in-hospital death and 12-month MI. CHADS-VASc score had a similar discrimination performance in predicting 12-month mortality as TIMI risk score and a better discrimination performance in predicting 12-month stroke than TIMI risk score. Thus, it can serve as an additive tool in identifying high-risk patients that require aggressive management.
- Subjects
MYOCARDIAL infarction; PEOPLE with diabetes; ATRIAL fibrillation; DIABETES; PROGNOSIS; STROKE
- Publication
Acta Diabetologica, 2016, Vol 53, Issue 5, p807
- ISSN
0940-5429
- Publication type
Article
- DOI
10.1007/s00592-016-0877-6