The Predictive Value of CHA2DS2-VASc Score on Residual Syntax Score in Patients With ST Segment Elevation Myocardial Infarction

Kalkan, Ali Kemal; Kahraman, Serkan; Avci, Yalcin; Bulut, Umit; Gulmez, Recep; Turkyilmaz, Ayse Beril; Erturk, Mehmet

doi:10.36660/abc.20210670

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Original Article • Arq. Bras. Cardiol. 119 (3) • Sept 2022 • https://doi.org/10.36660/abc.20210670 linkcopy

The Predictive Value of CHA2DS2-VASc Score on Residual Syntax Score in Patients With ST Segment Elevation Myocardial Infarction

Authorship SCIMAGO INSTITUTIONS RANKINGS

Background The CHA₂DS₂-VASc score is associated with adverse clinical outcomes in patients with cardiovascular disease. The residual Syntax score (rSS) is a scoring tool which has prognostic value in patients with ST segment elevation myocardial infarction (STEMI).

Objectives Our aim in this study is to investigate the predictive value of the CHA₂DS₂-VASc score on rSS in STEMI patients.

Methods A total of 688 consecutive patients with STEMI undergoing percutaneous coronary intervention were evaluated. Baseline demographic and clinical variables besides the CHA₂DS₂-VASc score were assessed. The patients were divided into two groups; patients with rSS of 8 or below as group 1 (509 patients) and more than 8 as group 2 (179 patients). A p-value < 0.05 was considered statistically significant.

Results The CHA₂DS₂-VASc score was higher in group 2 [1 (0-2); 1 (1-3), p<0.001] compared to group 1. The incidence of hypertension [151 (29.7%); 73 (40.8%), p=0.006], patients ≥75 years [18 (3.5%); 21 (11.7%), p<0.001], diabetes mellitus [85 (16.7%); 50 (27.9%), p=0.001] and vascular disease [12 (2.4%); 11 (6.1%), p=0.029] were higher in group 2. In multivariate logistic regression analysis, the CHA₂DS₂-VASc score (OR=1.355; 95%CI=1.171-1.568; p<0.001), age ≥75 years [OR=3.218; 95%CI=1.645-6.295; p=0.001] and diabetes mellitus [OR=1.670; 95%CI=1.091-2.557; p=0.018] were independent predictors of high rSS. The receiver-operating characteristic curve analysis demonstrated that the CHA₂DS₂-VASc score had good predictive value for high rSS with a cut-off value of 1.5 (area under curve (AUC): 0.611, 95% confidence interval (CI):0.562-0.659, p<0.001).

Conclusions The CHA₂DS₂-VASc score has a predictive value on rSS in patients with STEMI. The CHA₂DS₂-VASc score was also an independent predictor of higher rSS.

ST Elevation Myocardial Infarction; Percutaneous Coronary Intervention; Atrial Fibrillation

	Low rSS group (n= 509)	High rSS group (n= 179)	p
Age (years)	54±11	59±11	<0.001
Gender (female), n (%)	88 (17.3)	40 (22.3)	0.135
Smoking, n (%)	245 (48.1)	76 (42.5)	0.190
Hyperlipidemia, n (%)	49 (9.6)	28 (15.6)	0.028
COPD, n (%)	14 (2.8)	11 (6.1)	0.064
Ejection fraction (%)	50 (40-55)	45 (40-55)	0.154
Creatinine (mg/dl)	0.85 (0.74-1.0)	0.85 (0.72-1.05)	0.809
Hemoglobin (g/dl)	14.8 (13.4-15.8)	14.3 (13.0-15.3)	0.009
Leukocyte × 103/mm³	11.9 (9.61-14.07)	12.3 (9.6-15.2)	0.178
Thrombocyte × 103/mm³	261 (224-317)	264 (224-320)	0.849
Glucose (mg/dl)	132 (109-181)	155 (121-230)	<0.001
Total cholesterol (mg/dl)	198.5±42.3	200±45.4	0.689
LDL cholesterol (mg/dl)	120±37	122±39	0.615
HDL cholesterol (mg/dl)	40 (33.5-46)	41 (35-48)	0.068
Triglyceride (mg/dl)	181 (118-258)	160 (111-235)	0.139
Culprit lesion, n (%)
LAD	274 (53.8)	64 (35.8)^*	<0.001
CXA	79 (15.5)	36 (20.1)
RCA	156 (30.6)	79 (44.1)^†
CHA₂DS₂-VASc score	1 (0-2)	1 (1-3)	<0.001

	Low rSS group (n= 509)	High rSS group (n= 179)	p
Congestive heart failure/LV dysfunction, n (%)	150 (29.5)	60 (33.5)	0.312
Hypertension, n (%)	151 (29.7)	73 (40.8)	0.006
Age ≥75 years, n (%)	18 (3.5)	21 (11.7)	<0.001
Diabetes mellitus, n (%)	85 (16.7)	50 (27.9)	0.001
History of stroke/TIA or thromboembolism, n (%)	1 (0.2)	0 (0)	0.740
Vascular disease, n (%)	12 (2.4)	11 (6.1)	0.029
Age 65-74 years, n (%)	76 (14.9)	33 (18.4)	0.162
Sex category (female), n (%)	88 (17.3)	40 (22.3)	0.135

	Low rSS group (n= 509)	High rSS group (n= 179)	p
CHA₂DS₂-VASc score: 0, n (%)	195 (38.3)	44 (24.6)	0.001
CHA₂DS₂-VASc score: 1, n (%)	149 (29.3)	47 (26.3)	0.442
CHA₂DS₂-VASc score: 2, n (%)	97 (19.1)	42 (23.5)	0.207
CHA₂DS₂-VASc score: 3, n (%)	43 (8.4)	20 (11.2)	0.349
CHA₂DS₂-VASc score: 4, n (%)	18 (3.5)	17 (9.5)	0.003
CHA₂DS₂-VASc score: 5, n (%)	6 (1.2)	7 (3.9)	0.029
CHA₂DS₂-VASc score: 6, n (%)	1 (0.2)	2 (1.1)	0.167

	Univariate analysis			Multivariate analysis
	Odds ratio	95% CI (Lower-Upper)	p	Odds ratio	95% CI (Lower-Upper)	p
Hyperlipidemia	1.741	1.056-2.868	0.030	1.605	0.956-2.696	0.074
COPD	2.315	1.031-5.198	0.042	1.522	0.637-3.638	0.344
Hemoglobin	0.892	0.815-0.977	0.014	0.977	0.883-1.081	0.658
CHA₂DS₂-VASc score	1.374	1.210-1.560	<0.001	1.355	1.171-1.568	<0.001
Culprit lesion RCA	1.788	1.260-2.537	0.001	1.963	1.360-2.831	<0.001

	Univariate analysis			Multivariate analysis
	Odds ratio	95% CI (Lower-Upper)	p	Odds ratio	95% CI (Lower-Upper)	p
CHF/LV dysfunction	1.207	0.838-1.737	0.312
Hypertension	1.633	1.146-2.325	0.007	1.296	0.888-1.892	0.179
Age ≥75 years	3.626	1.884-6.977	<0.001	3.218	1.645-6.295	0.001
Diabetes mellitus	1.933	1.295-2.887	0.001	1.670	1.091-2.557	0.018
Stroke/TIA	0.000	0.000	1.000
Vascular disease	2.712	1.175-6.260	0.019	2.059	0.858-4.942	0.106
Age 65-74 years	1.288	0.821-2.019	0.270
Sex (female)	1.377	0.905-2.095	0.136

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[TFN1001] ^*: lower than the low rSS group,^†: higher than the low rSS group. COPD: chronic obstructive pulmonary disease; CXA: circumflex artery; HDL: high density lipoprotein; LAD: left anterior descending; LDL: low density lipoprotein; RCA: right coronary artery; rSS: residual Syntax score.