P1563CHA2DS2-VASc score predicts mortality and readmission in octogenarian patients with non-ST-segment elevation myocardial infarction

Abstract

Abstract Background CHA2DS2-VASc Score is widely used to predict thromboembolic risk in patients with Atrial Fibrillation (AF). We ought to study if this score predicts outcomes in elderly patients with Non ST-segment Elevation Myocardial Infarction (NSTEMI). Methods The multicenter LONGEVO-SCA prospective registry included 532 unselected patients with NSTEMI aged ≥80 years. Data to calculate CHA2DS2-VASc Score were available in 523 patients (98.3%). They were classified according to CHA2DS2-VASc Score: group 1 (score 0–4), and 2 (5–9). We studied outcomes in terms of mortality or readmission at 6 months follow-up. Results A total of 266 patients (51%) had a high CHA2DS2-VASc Score (group 2). They were more often women, with more cardiovascular risk factors like hypertension or diabetes mellitus, and history of previous stroke and cardiovascular disease and heart failure (all, p=0.001). Geriatric syndromes (Barthel Index, Lawton Brody, cognitive impairment and frailty) and Charlson index were worse in this group (all, p=0.001). They had poorer clinical status on admission, with worse Killip class and lower left ventricle ejection fraction (all, p=0.001), and developed new onset AF more often during admission (12.4% vs. 6.6%, p=0,024). At six months follow-up, patients in group 2 had higher reinfarction, all cause mortality, and mortality or readmission rates (all, p=0.001). (Table) A CHA2DS2-VASc Score >4 predicted mortality (HR 2,60 [95% CI 1,48–4,55], p<0,001) (Figure 1) and was associated with mortality or readmission at 6 months (HR 2.07 [CI 95% 1.51–2.84], p<0.001). CHADS VASC2 0–4 (n=257) CHADS >4 (n=266) p Geriatric syndromes Barthel Index 94 (13) 85 (22) 0.001 Lawton brody 6.2 (2) 4.9 (3) 0.001 Charlson Index 1.5 (1) 3.3 (2) 0.001 Cognitive impairment 0.001 No 201 (79.1) 155 (58.7) Mild 49 (19.3) 100 (37.9) Severe 4 (1.6) 9 (3.4) Nutritional risk (MNA-SF*) 122 (48) 149 (57.1) 0.040 Frailty (FRAIL scale) 0.001 Non-frail 111 (43.2) 69 (25.9) Prefrail 102 (39.7) 101 (38) Frail 44 (17.1) 96 (36.1) Outcomes at 6 months Reinfarction 26 (6.9) 16 (13.9) 0.018 Mortality or readmission 111 (28.9) 60 (50.4) 0.001 All cause mortality 38 (9.9) 24 (20.2) 0.003 Conclusions A CHA2DS2-VASc sore>4 is present in half of octogenarians with NSTEMI and is associated with a poor outcome.