Abstract P577: An Association Between CHADS-VASc Score Morbidities, Coronary Artery Disease Severity, and Post-Elective Percutaneous Coronary Intervention Stroke and Death

Abstract

Background: The CHADS-VASc score is a clinical prediction tool used to assess stroke risk in patients with atrial fibrillation or flutter. An association between CHADS-VASc score morbidities and outcomes of elective percutaneous coronary intervention (PCI) has not been well studied. Methods: This cohort study utilized 2015 NY State Angioplasty Registry data and included 33,568 consecutive patients. Patients with prior CABG, shock, or acute coronary syndrome (ACS) within 24-hours of PCI placement were excluded. CHADS-VASc score was calculated by adding 1 point each for positive history of congestive heart failure (CHF), diabetes mellitus (DM), vascular disease, age 65-75 years old, female sex, and 2 points each for age >75 years old and history of stroke. As the Registry does not record history of hypertension, the calculated score used 0 for hypertension in all patients. Results: In the studied cohort, 68.4% were males, mean age 65.5 +/- 11.5 years old. Increased burden of CHADS-VASc morbidities was associated with more advanced CAD, including 3 vessel and left-main (LM) CAD. Of patients with CHADS-VASc score of 0, 16.3% had 3 vessel disease and 0.7% had LM disease, score of 3 had 20% 3 vessel disease and 2.3% LM disease, and score of 6 and/or 7 had 31.2% 3 vessel disease and 5.7% LM disease (p<0.0001). Increased burden of CHADS-VASc morbidities was also associated with increasing incidence of post-elective PCI stroke and mortality. Stroke was observed in 0.03% of cases with score of 0, 0.3% of cases with score of 3, and 1.4% of cases with score of 6 and/or 7 (p<0.0001). Mortality rate was 0.05% in patients with score of 0, 0.7% with score of 3, and 1.4% in patients with score of 6 and/or 7 (p<0.0001). Conclusions: This pilot study indicates that increased burden of CHADS-VASc morbidities is associated with more advanced CAD and increased incidence of post-elective PCI stroke and mortality. These data suggest that the simple CHADS-VASc calculation may be useful in identifying patients at greater risk of post-elective PCI complications, aid in estimating patient prognosis, and provide a reference point for clinicians contemplating PCI in stable CAD patients.