0128: CHA2DS2-VASc score estimates in-hospital mortality beyond GRACE score after acute myocardial infarction
Résumé
Background and aims
CHA2DS2VASc score have recently been suggested to predict death in patients with Atrial Fibrillation (AF). In acute myocardial infarction (AMI), silent AF is more common than symptomatic AF and associated with poor prognosis. In patients with AMI, we aimed to assess the distribution of CHA2DS2VASc score in patients with silent or symptomatic AF and the association of the score with mortality.
Methods
849 consecutive AMI were prospectively analyzed by continuous ECG monitoring (CEM) <48 hours after admission. Silent AF was defined as asymptomatic episodes lasting >30 sec. Symptomatic AF was defined as any AF occurring on ECG during the hospital stay, resulting in clinical symptoms or need for urgent cardioversion. The population was studied into three groups: No AF, Silent AF, and symptomatic AF. CHA2DS2VASc and GRACE risk score were calculated for risk assessment.
Results
One hundred and thirty five patients (16%) developed silent AF and 45(5%) had symptomatic AF. Compared with the no AF group, patients with silent AF were markedly older 80 (67-85) vs. 62 (53-75) years; p<0.001), more frequently women (58 (43%) vs. 198 (30%); p=0.006), and less smoker (26 (20%) vs. 242 (36%); with p<0.001). Patients with silent and symptomatic AF, had higher CHA2DS2VASc score than patients without AF (5[4-6] and 5[4-6] vs 3[2-4], p<0.001).
CHA2DS2VASc score was similar in patients with silent and symptomatic AF (p=0.550). Mortality was higher in silent AF and symptomatic AF than in patients without AF ((14 (10.4%) and 8 (17.8%) vs 9 (1.3%)), p<0.001). CHA2DS2VASc score was associated with mortality in patients with AF, but not in patients without AF (OR[95% CI]: 1.32[1.02-1.72], p=0.036 and 1.22[0.88-1.71], p=0.236, respectively).
In the whole population, optimal threshold for predicting death for GRACE and CHA2DS2VASc risk scores were obtained by Receiver Operating Characteristic (ROC) curve (i.e. 153 and 4, respectively).
High CHA2DS2VASc (≥4) and GRACE (≥153) scores independently stratified mortality. By multivariate analysis, high CHA2DS2VASc score was an independent explanatory variable for death after AMI (OR[95% CI): 3.89[1.08-13.93]; p=0.037), beyond GRACE risk score (OR[95% CI]: 9.77[2.74-34.80]; p<0.001).
Conclusion
Patients with silent AF have level of CHA2DS2VASc risk similar to patients with symptomatic AF. A high CHA2DS2VASc score is associated with mortality, even when adjusted for GRACE risk score. These data suggest that CHA2DS2VASc score could improve risk stratification after AMI.