CHA2DS2‐VASc and R2CHA2DS2‐VASc scores predict mortality in high cardiovascular risk population

Background The CHA2DS2‐VASc score, widely used to estimate cardioembolic risk in patients with atrial fibrillation (AF), appears to be useful also in predicting vascular adverse events and death in different sets of patients without AF. The R2CHA2DS2‐VASc score, which includes renal impairment, allows a better prediction of death and thromboembolism in patients without AF. The aims of our study were to assess, in a large sample of patients at high cardiovascular (CV) risk, (i) the correlation between CHA2DS2‐VASc and R2CHA2DS2‐VASc with all‐cause mortality, and (ii) to compare the performances of CHA2DS2‐VASc and R2CHA2DS2‐VASc in predicting all‐cause mortality. Methods In this single‐centre prospective observational study, conducted at the Research Hospital ‘Casa Sollievo della Sofferenza’ between June 2016 and December 2018, 1017 CV patients at high risk of undergoing coronary angiography were enrolled. Results CHA₂DS₂‐VASc and R2CHA2DS2‐VASc scores significantly associated with all‐cause mortality. For each one‐point increase in CHA2DS2‐VASc or R2CHA2DS2‐VASc scores, mortality increased by almost 1.5‐fold. The R2CHA2DS2‐VASc score (C‐statistic = 0.71; 95% CI = 0.65–76) outperformed the CHA2DS2‐VASc score (C‐statistic = 0.66; 95% CI = 0.61–0.71) in predicting 4‐year mortality (delta C‐statistic = 0.05; 95% CI = 0.02–0.07). The better predictive ability of the R‐CHA2DS2‐VASc score was also demonstrated by an IDI = 0.027 (95% CI = 0.021–0.034, p