Association of CHA₂DS₂-VASc-HSF Score with Coronary Artery Disease Severity in Patients with Non-ST Segment Elevation Myocardial Infarction

Author(s): Md. Mostafa-Al-Rasel, Syed Nasir Uddin, Mohammad Abul Khair, AKM Monwarul Islam, Tariq Ahmed Chowdhury, Md. Wareshuzzaman, Md. Faisal Bin Selim Khan, Syed Mahmud Ali, Md. Rashidul Hassan, Farida Parvin

Background and Objectives: Due to the wide spectrum of risk for death and recurrent events among patients with Non-ST Elevation Myocardial Infarction (NSTEMI), management guidelines emphasize the importance of early risk stratification. In addition to prognostic assessment, predicting the anatomical extension of coronary artery disease (CAD) is potentially useful for clinical decisions. The aim of the study was to determine whether the CHA2DS2-VASc-HSF score correlates with the angiographic extent and severity of CAD in patients with NSTEMI.

Methods: It was a cross-sectional observational study. A total of 80 patients with NSTEMI were enrolled. Based on the CHA2DS2-VASc- HSF score, the patients were divided into low (≤4) and high (>4) risk groups. All patients underwent coronary angiography during the index hospitalization and the severity of CAD was assessed by the SYNTAX score. The association between the CHA2DS2-VASc-HSF score and the SYNTAX score was evaluated.

Results: The mean age of patients was 50.58±9.53 and 54.48±10.66 years for group I and group II respectively with the majority (81.2%) being male. The mean CHA2DS2-VASc-HSF score of the patients was 2.68±0.92 in group I and 5.48±0.60 in group II (P value=<0.001). The median SYNTAX score was 7.50 (range 0.0 to 24.0) in Group I and 23.3 (range 0.0 to 39.0) in Group II (P value=<0.001). The CHA2DS2-VASc- HSF score was positively and significantly correlated with the SYNTAX score (Spearman’s ρ =0.703, p<0.001). A CHA2DS2-VASc-HSF score of 4.5 has 86.7% sensitivity and 72.0% specificity to detect severe coronary artery involvement (SYNTAX score >22).

Conclusion: The study demonstrated that the CHA2DS2-VASc-HSF score was associated with the severity of coronary artery disease in patients with NSTEMI. Notably, those with elevated CHA2DS2-VASc-HSF scores tended to have higher SYNTAX scores.