The CHADS2 and CHA2DS2-VASc scores predict adverse vascular function, ischemic stroke and cardiovascular death in high-risk patients without atrial fibrillation: role of incorporating PR prolongation

Atherosclerosis. 2014 Dec;237(2):504-13. doi: 10.1016/j.atherosclerosis.2014.08.026. Epub 2014 Aug 30.

Abstract

Objectives: To investigate whether the CHADS2 and CHA2DS2-VASc scores have clinical utility for prediction of adverse vascular function and vascular dysfunction-mediated incident cardiovascular (CV) events among high-risk patients without atrial fibrillation (AF), and the additional value of incorporating PR prolongation to the scores.

Methods: We analyzed 579 high-risk CV outpatients without clinical AF in a prospective cohort for new-onset ischemic stroke, myocardial infarction (MI), congestive heart failure (CHF), and CV death. Brachial flow-mediated dilation (FMD) and nitroglycerin-mediated dilatation (NMD), carotid intima-media thickness (IMT) and pulse wave velocity (PWV) were determined.

Results: Baseline CHADS2 score was associated with lower FMD (Pearson r = -0.16, P < 0.001) and NMD (r = -0.17, P < 0.001), higher carotid IMT (r = 0.30, P < 0.001) and PWV (r = 0.35, P < 0.001; similar for CHA2DS2-VASc score: All P < 0.05). After follow-up of 63 ± 11 months, 82 patients (14.2%) developed combined CV endpoint. ROC curve analysis showed that both CHADS2 and CHA2DS2-VASc scores were predictors for ischemic stroke (C-Statistic: CHADS2 0.70, P = 0.004; CHA2DS2-VASc 0.68, P = 0.010), MI (CHADS2 0.63, P = 0.030; CHA2DS2-VASc 0.70, P = 0.001), and CV death (CHADS2 0.63, P = 0.022; CHA2DS2-VASc 0.65, P = 0.011). Higher CHADS2 score was associated with reduced event-free survival from combined CV endpoints (log-rank = 16.7, P < 0.001) with differences potentiated if stratified by CHA2DS2-VASc score (log-rank = 29.2, P < 0.001). Incorporating PR prolongation, the CHA2DS2-VASc-PR score achieved the highest C-Statistic for CV death prediction (0.70, P < 0.001) superior to the CHADS2 score (chi-square: 12.1, P = 0.0005).

Conclusions: The CHADS2 and CHA2DS2-VASc predict vascular dysfunction and cardiovascular events in high-risk CV patients without clinical AF, with further improved performance incorporating PR prolongation.

Keywords: Adverse cardiovascular events; CHADS(2) and CHA(2)DS(2)-VASc scores; Cardiovascular continuum; PR prolongation; Risk prediction; Vascular dysfunction.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Atrial Fibrillation / physiopathology*
  • Body Mass Index
  • Cardiovascular Diseases / diagnosis*
  • Cardiovascular Diseases / physiopathology
  • Carotid Intima-Media Thickness
  • Dilatation
  • Electrocardiography
  • Female
  • Follow-Up Studies
  • Health Status Indicators
  • Heart Failure / physiopathology
  • Humans
  • Male
  • Middle Aged
  • Myocardial Ischemia / pathology
  • Nitroglycerin / chemistry
  • Proportional Hazards Models
  • Prospective Studies
  • Pulse Wave Analysis
  • ROC Curve
  • Risk Assessment
  • Risk Factors
  • Sex Factors
  • Tomography, Emission-Computed, Single-Photon

Substances

  • Nitroglycerin