Relationship between CHA2DS2-VASC score on admission to emergency department and in-hospital major adverse cardiovascular events in patients diagnosed with ST-elevation myocardial infarction

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Inotroduction . CHA₂DS₂-VASc scoring system, which includes traditional risk factors of coronary artery disease, is actually created to determine the risk of thromboembolism in patients with atrial fibrillation. In this study; the value of CHA₂DS₂-VASc score, which can be calculated easily on admission, was evaluated for predicting in-hospital adverse outcomes in ST elevation miyocardial infarction (STEMI) patients without atrial fibrillation. Method This was a single center cross-sectional study. 1933 STEMI patients enrolled to the study. Primary end points include in-hospital death, cardiopulmonary arrest and cerebrovascular accident and were identified as MACE Results MACE rate was 10% (193 patients), in-hospital mortality rate was 9% (169 patients).In proportional logistic regression analysis, CHA₂DS₂-VASc score was an independent predictor for MACE (OR and CI 95%, 2.31[1.37-3.90]; p value:0.0016). In the regression analysis, the CHA₂DS₂-VASc score was taken as an uncatagorized continuous variable, and the relationship between the CHA₂DS₂-VASc score and MACE was observed to be linear. Additionally heart rate (OR and 95% CI, 1.56 [0.97- 2.50]; p value: 0.0242), killip class on admission (OR and 95% CI, 24.19[10.74-54.46]; p value <0.0001), creatinine level on admission (OR and 95% CI, 1.54 [1.10-2.16]; p value: 0.0024), peak CK-MB level (OR and 95% GA, 1.63 [0.98-2.70]; p value: 0.0001) and presence of no-reflow (OR and 95% CI, 2.45 [1.25-4.80]; p value: 0.0085) were indendified as other independent predictors of MACE. Conclusion CHA₂DS₂-VASc score was observed as an indepented predictor for MACE in STEMI patients. To evaluate the relationship between CHA₂DS₂-VASc score and outcomes, the linear analysis of the CHA₂DS₂-VASc score without categorization in prediction model is used and this is the main difference of our study from others. Table-1 Variables Odss Ratio (OR) and 95% CI p value CHA₂DS₂-VASc ( 0 to 3) 2.31 (1.37-3.90) p = 0,0016 Heart Rate (Beats per minute) ( 68 to 94) 1.56 (0.97-2.50) p =0.0242 Systolic Blood Pressure (mmHg) ( 115 to 156) 0.83 (0.51-1.34) p = 0.3523 Killip Class ( I to IV) 24.19 (10.74-54.46) p < 0.0001 Hemoglobin (g/dL) ( 12 to 15) 0.96 (0.54-1.70) p = 0.4066 Creatinine ( mg/dL) (0.74 to 1.0) 1.54 (1.10-2.16) p = 0.0024 Peak CK-MB (IU/L) (40.8 to 165.1) 1.63 (0.98-2.70) p = 0.0001 No-reflow (yes) 2.45 (1.25-4.80) p = 0.0085 Independent predictors of MACE in STEMI patients according to penalized proportional odds logistic regression analysis Abstract Figure. Partial impact plots of predictors