Prognostic value of GRACE and CHA2DS2-VASc score among patients with atrial fibrillation undergoing percutaneous coronary intervention.

Abstract

AIMS:

The GRACE and CHA2DS2-VASc risk score are developed for risk stratification in patients with acute coronary syndrome and AF, respectively. We aimed to assess the predictive performance of the GRACE score and CHA2DS2-VASc score among patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI).

METHODS:

Consecutive patients with a diagnosis of AF admitted to our hospital for PCI between January 2016 and December 2018 were included and followed up for at least 1 year. The primary endpoint was a composite of major adverse cardiac events (MACEs) including all-cause mortality, repeat revascularization, myocardial infarction, or ischaemic stroke.

RESULTS:

A total of 1452 patients were identified. Cox regression demonstrated that the GRACE (HR 1.014, 95% CI 1.008-1.020, p < 0.001) but not the CHA2DS2-VASc score was associated with the risk of MACEs. Both GRACE and CHA2DS2-VASc scores were predictive of all-cause mortality with HR of 1.028 (95% CI 1.020-1.037, p < 0.001) and 1.334 (95% CI 1.107-1.632, p = 0.003). Receiver operating characteristic analyses showed both scores had similar discrimination capacity for all-cause mortality (C-statistic: 0.708 for GRACE vs. 0.661 for CHA2DS2-VASc, p = 0.299). High GRACE score was also significantly associated with increased risk of ischaemic stroke (HR 1.018, 95% CI 1.005-1.031, p = 0.006) and major bleeding (HR 1.012, 95% CI 1.001-1.024, p = 0.039), whereas high CHA2DS2-VASc score was not.

CONCLUSIONS:

High GRACE score but not CHA2DS2-VASc score were both associated with an increased risk of MACEs after PCI in patients with AF. The GRACE and CHA2DS2-VASc scores have similar predictive performance for predicting all-cause mortality.Key messages:In patients with AF undergoing PCI, increasing GRACE but not CHA2DS2-VASc scores was independently associated high risk of MACEs.The GRACE score could also help identify patients at higher risk of stroke and major bleeding.Both GRACE and CHA2DS2-VASc scores showed good ability in the prediction of all-cause mortality.

• Authors: Tingting Guo, Ziwei Xi, Hong Qiu, Yong Wang, Jianfeng Zheng, Kefei Dou, Bo Xu, Shubin Qiao, Weixian Yang, Runlin Gao
• Journal: Annals of medicine (Ann Med) Vol. 53 Issue 1 Pg. 2215-2224 (12 2021) ISSN: 1365-2060 [Electronic] England
• PMID: 34791980 (Publication Type: Journal Article, Observational Study)

Topics

• Adult
• Aged
• Aged, 80 and over
• Atrial Fibrillation (complications, diagnosis, epidemiology, surgery)
• Female
• Hepatic Insufficiency (epidemiology)
• Humans
• Male
• Middle Aged
• Organ Dysfunction Scores
• Percutaneous Coronary Intervention (adverse effects)
• Prognosis
• Renal Insufficiency (epidemiology)
• Retrospective Studies
• Risk Assessment (methods)
• Stroke (diagnosis, epidemiology, etiology)