Echocardiography and CHA2DS2-VASc-HS score with adverse in-hospital outcomes in patients with non-st segment elevation myocardial infarction

Abstract

Background After myocardial infarction, optimal clinical management depends critically on Echocardiography. Echocardiography is a versatile imaging modality for the management of patients with chest pain and assessment of left ventricular systolic function, diastolic function, and even myocardial and coronary perfusion which provides information regarding cardiac function and hemodynamics. Remodelling and heart failure, presence of inducible ischaemia, presence of dysfunctional viable myocardium, future risk of adverse events including risk of ventricular arrhythmias, need for anticoagulation, and other questions should be addressed. But it has some limitations. A clinical scoring is compared with echocardiography. Early detection of patients with non-ST segment elevation myocardial infarction (NSTEMI) who would suffer from adverse in-hospital outcomes is important for the therapeutic decision. Recently it was described that CHA2DS2-VASc-HS and CHA2DS2-VASc score is a predictor for severity and adverse in-hospital outcomes in patients with stable coronary artery disease (CAD) and acute coronary syndrome. The aim of our study was to assess the accuracy of the CHA2DS2-VASc-HS score predicting adverse in-hospital outcomes in NSTEMI patients. Methods 120 patients with NSTEMI were enrolled in this study. The CHA2DS2-VASc-HS score was calculated. The study subjects were divided into two groups. Patients’ with CHA2DS2-VASc-HS score > 4 were put into group I and score≤ 4 into group II. They were treated as per hospital treatment protocol and followed-up for adverse in-hospital outcomes (Heart failure, cardiogenic shock, recurrent ischemic pain, significant arrhythmia and death). Results It was observed that, patients with CHA2DS2-VASc-HS score > 4 had more adverse in-hospital outcomes than CHA2DS2-VASc-HS score ≤ 4 (20% vs. 3.3%, p = 0.01). Group I patients developed cardiogenic shock 10%, heart failure 4%, recurrent ischemia 11.7%, significant arrhythmia 1.7% and death 1.7% than group II patients (1.7%, 3.3%, 3.3%, 0% and 0% respectively). By risk measurement, CHA2DS2-VASc-HS score > 4 emerged as a risk factor for developing adverse in-hospital outcome (Relative risk = 6). Conclusion NSTEMI patients with high CHA2DS2-VASc-HS score have more adverse in-hospital outcomes. This score, which involves only clinical parameters, can be used as a predictor of outcomes in this group of patients.