Prognostic impact of renal dysfunction in patients with acute coronary syndrome-role beyond the CHA2DS2-VASc score: Data from Taiwan acute coronary syndrome full spectrum registry

Prognostic impact of renal dysfunction in patients with acute coronary syndrome-role beyond the CHA2DS2-VASc score: Data from Taiwan acute coronary syndrome full spectrum registry

Aim CHA2DS2‐VASc score has been proven to have great prognostic value in patients with acute coronary syndrome (ACS). We aimed to determine whether the addition of renal dysfunction in the CHA2DS2‐VASc score would improve the prognostic impact of the scoring system to predict prognosis among ACS pat...

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Veröffentlicht in:Nephrology (Carlton, Vic.) Vic.), 2016-07, Vol.21 (7), p.583-591
Hauptverfasser: Chua, Su-Kiat, Lo, Huey-Ming, Chiu, Chiung-Zuan, Shyu, Kou-Gi
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CHA2DS2-VASc score
death
myocardial infarction
Renal dysfunction
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container_issue 7
container_start_page 583
container_title Nephrology (Carlton, Vic.)
container_volume 21
creator Chua, Su-Kiat
Lo, Huey-Ming
Chiu, Chiung-Zuan
Shyu, Kou-Gi
description Aim CHA2DS2‐VASc score has been proven to have great prognostic value in patients with acute coronary syndrome (ACS). We aimed to determine whether the addition of renal dysfunction in the CHA2DS2‐VASc score would improve the prognostic impact of the scoring system to predict prognosis among ACS patients. Methods A total of 3031 ACS patients were prospectively enrolled at 39 hospitals and followed for 1 year. The patients were divided into three groups based on estimated glomerular filtration rate (eGFR) (group 1, eGFR>90; group 2, eGFR between 60 and 90; and group 3, eGFR
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We aimed to determine whether the addition of renal dysfunction in the CHA2DS2‐VASc score would improve the prognostic impact of the scoring system to predict prognosis among ACS patients. Methods A total of 3031 ACS patients were prospectively enrolled at 39 hospitals and followed for 1 year. The patients were divided into three groups based on estimated glomerular filtration rate (eGFR) (group 1, eGFR&gt;90; group 2, eGFR between 60 and 90; and group 3, eGFR&lt;60 mL/min per 1.73 m2). The occurrence of subsequent myocardial infarction (MI), stroke, or death was recorded. Results As renal function progressively decreased from group 1 to 3, the patients were, respectively older and had higher incidence of comorbidity, worse Killip classification, and less evidence‐based medical therapies. The rate of subsequent MI, stroke or death increased from 3.4% in group 1 to 7.4% in group 2 and 17.2% in group 3 (P &lt; 0.001). Renal dysfunction (eGFR&lt;60 mL/min per 1.73 m2) and CHA2DS2‐VASc scores were both significant predictors of adverse events in multivariable regression analyses. Renal dysfunction can further stratify patients with CHA2DS2‐VASc score of 0 or 1 into 3 groups with different adverse event rates (group 1, 3.0%; group 2, 4.1%; and group 3, 9.2%, P &lt; 0.001). A new scoring system (R‐CHA2DS2‐VASc score) derived by assigning one more point for eGFR ≤ 60 mL/min per 1.73 m2 to the CHA2DS2‐VASc score could improve its predictive accuracy (area under the receiver operating curve, 0.70 vs. 0.66, P &lt; 0.001). Conclusions Renal dysfunction is a significant risk factor of future adverse events in ACS patients and may improve the prognostic impact of the CHA2DS2‐VASc score. Summary at a Glance This multi‐centre study from Taiwan applied the CHA2DS2‐VASc Score, a score used to consider anticoagulation in patients with atrial fibrillation, to patients presenting with acute coronary syndromes to assess their risk of future myocardial infarction, stroke or death. Among patients with both low (0 or 1) and high (&gt; = 2) CHA2DS2‐VASc Scores, risk increased markedly as kidney function declined. Addition of a kidney function parameter to the Score also led to some improvement in score performance.</description><identifier>ISSN: 1320-5358</identifier><identifier>EISSN: 1440-1797</identifier><identifier>DOI: 10.1111/nep.12653</identifier><language>eng</language><publisher>Blackwell Publishing Ltd</publisher><subject>CHA2DS2-VASc score ; death ; myocardial infarction ; Renal dysfunction</subject><ispartof>Nephrology (Carlton, Vic.), 2016-07, Vol.21 (7), p.583-591</ispartof><rights>2015 Asian Pacific Society of Nephrology</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fnep.12653$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fnep.12653$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1416,27915,27916,45565,45566</link.rule.ids></links><search><creatorcontrib>Chua, Su-Kiat</creatorcontrib><creatorcontrib>Lo, Huey-Ming</creatorcontrib><creatorcontrib>Chiu, Chiung-Zuan</creatorcontrib><creatorcontrib>Shyu, Kou-Gi</creatorcontrib><title>Prognostic impact of renal dysfunction in patients with acute coronary syndrome-role beyond the CHA2DS2-VASc score: Data from Taiwan acute coronary syndrome full spectrum registry</title><title>Nephrology (Carlton, Vic.)</title><addtitle>Nephrology</addtitle><description>Aim CHA2DS2‐VASc score has been proven to have great prognostic value in patients with acute coronary syndrome (ACS). We aimed to determine whether the addition of renal dysfunction in the CHA2DS2‐VASc score would improve the prognostic impact of the scoring system to predict prognosis among ACS patients. Methods A total of 3031 ACS patients were prospectively enrolled at 39 hospitals and followed for 1 year. The patients were divided into three groups based on estimated glomerular filtration rate (eGFR) (group 1, eGFR&gt;90; group 2, eGFR between 60 and 90; and group 3, eGFR&lt;60 mL/min per 1.73 m2). The occurrence of subsequent myocardial infarction (MI), stroke, or death was recorded. Results As renal function progressively decreased from group 1 to 3, the patients were, respectively older and had higher incidence of comorbidity, worse Killip classification, and less evidence‐based medical therapies. The rate of subsequent MI, stroke or death increased from 3.4% in group 1 to 7.4% in group 2 and 17.2% in group 3 (P &lt; 0.001). Renal dysfunction (eGFR&lt;60 mL/min per 1.73 m2) and CHA2DS2‐VASc scores were both significant predictors of adverse events in multivariable regression analyses. Renal dysfunction can further stratify patients with CHA2DS2‐VASc score of 0 or 1 into 3 groups with different adverse event rates (group 1, 3.0%; group 2, 4.1%; and group 3, 9.2%, P &lt; 0.001). A new scoring system (R‐CHA2DS2‐VASc score) derived by assigning one more point for eGFR ≤ 60 mL/min per 1.73 m2 to the CHA2DS2‐VASc score could improve its predictive accuracy (area under the receiver operating curve, 0.70 vs. 0.66, P &lt; 0.001). Conclusions Renal dysfunction is a significant risk factor of future adverse events in ACS patients and may improve the prognostic impact of the CHA2DS2‐VASc score. Summary at a Glance This multi‐centre study from Taiwan applied the CHA2DS2‐VASc Score, a score used to consider anticoagulation in patients with atrial fibrillation, to patients presenting with acute coronary syndromes to assess their risk of future myocardial infarction, stroke or death. Among patients with both low (0 or 1) and high (&gt; = 2) CHA2DS2‐VASc Scores, risk increased markedly as kidney function declined. 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We aimed to determine whether the addition of renal dysfunction in the CHA2DS2‐VASc score would improve the prognostic impact of the scoring system to predict prognosis among ACS patients. Methods A total of 3031 ACS patients were prospectively enrolled at 39 hospitals and followed for 1 year. The patients were divided into three groups based on estimated glomerular filtration rate (eGFR) (group 1, eGFR&gt;90; group 2, eGFR between 60 and 90; and group 3, eGFR&lt;60 mL/min per 1.73 m2). The occurrence of subsequent myocardial infarction (MI), stroke, or death was recorded. Results As renal function progressively decreased from group 1 to 3, the patients were, respectively older and had higher incidence of comorbidity, worse Killip classification, and less evidence‐based medical therapies. The rate of subsequent MI, stroke or death increased from 3.4% in group 1 to 7.4% in group 2 and 17.2% in group 3 (P &lt; 0.001). Renal dysfunction (eGFR&lt;60 mL/min per 1.73 m2) and CHA2DS2‐VASc scores were both significant predictors of adverse events in multivariable regression analyses. Renal dysfunction can further stratify patients with CHA2DS2‐VASc score of 0 or 1 into 3 groups with different adverse event rates (group 1, 3.0%; group 2, 4.1%; and group 3, 9.2%, P &lt; 0.001). A new scoring system (R‐CHA2DS2‐VASc score) derived by assigning one more point for eGFR ≤ 60 mL/min per 1.73 m2 to the CHA2DS2‐VASc score could improve its predictive accuracy (area under the receiver operating curve, 0.70 vs. 0.66, P &lt; 0.001). Conclusions Renal dysfunction is a significant risk factor of future adverse events in ACS patients and may improve the prognostic impact of the CHA2DS2‐VASc score. Summary at a Glance This multi‐centre study from Taiwan applied the CHA2DS2‐VASc Score, a score used to consider anticoagulation in patients with atrial fibrillation, to patients presenting with acute coronary syndromes to assess their risk of future myocardial infarction, stroke or death. Among patients with both low (0 or 1) and high (&gt; = 2) CHA2DS2‐VASc Scores, risk increased markedly as kidney function declined. Addition of a kidney function parameter to the Score also led to some improvement in score performance.</abstract><pub>Blackwell Publishing Ltd</pub><doi>10.1111/nep.12653</doi><tpages>9</tpages></addata></record>
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subjects CHA2DS2-VASc score
death
myocardial infarction
Renal dysfunction
title Prognostic impact of renal dysfunction in patients with acute coronary syndrome-role beyond the CHA2DS2-VASc score: Data from Taiwan acute coronary syndrome full spectrum registry
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