CHA2DS2-VASc score is useful in predicting poor 12-month outcomes following myocardial infarction in diabetic patients without atrial fibrillationReportar como inadecuado




CHA2DS2-VASc score is useful in predicting poor 12-month outcomes following myocardial infarction in diabetic patients without atrial fibrillation - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Acta Diabetologica

, Volume 53, Issue 5, pp 807–815

First Online: 23 June 2016Received: 07 May 2016Accepted: 08 June 2016

Abstract

AimsTIMI risk score and GRACE risk model are widely available and accepted scores for risk assessment in STEMI patients and include predictors of poor outcomes. CHA2DS2-VASc is a validated score for predicting embolic-stroke risk in patients with non-valvular atrial fibrillation. Its components contribute to the worse prognosis following myocardial infarction. The advantage of the CHA2DS2-VASc score in comparison with other risk scores is that it provides a comprehensive, fast, and simple method for physicians in risk evaluation that requires no calculators or computers. Therefore, we have set out to examine the prognostic significance of CHA2DS2-VASc score following STEMI in diabetic patients without AF.

MethodsA total of 472 patients with diabetes mellitus and STEMI undergoing primary PCI were enrolled. Based on the estimated CHA2DS2-VASc score, the study population was divided into three groups: group 1 N = 111 with a moderate CHA2DS2-VASc score of 2 or 3; group 2 N = 257 with a high CHA2DS2-VASc score of 4 or 5; and group 3 N = 104 with a very high CHA2DS2-VASc score of 6 or higher.

ResultsIn diabetic patients with STEMI, the median of CHA2DS2-VASc score was 4 interquartile range 3–5. In-hospital mortality rate was similar across three groups. CHA2DS2-VASc score was not a risk factor of in-hospital mortality. ROC analysis revealed good diagnostic value of CHA2DS2-VASc score in predicting long-term mortality AUC 0.62 95 % CI 0.57–0.66 P = 0.0003 and stroke AUC 0.75 95 % CI 0.71–0.79 P = 0.0003, but no value in predicting long-term myocardial infarction. CHA2DS2-VASc score was an independent predictor of 12-month mortality and stroke. One-point increment in CHA2DS2-VASc score was associated with an increase in the risk of 12-month death by 24 % and for 12-month stroke by 101 %.

ConclusionsIn diabetic patients with STEMI and no previous AF, median CHA2DS2-VASc score was high 4 points and predicted 12-month death and stroke. However, it failed to predict in-hospital death and 12-month MI. CHA2DS2-VASc score had a similar discrimination performance in predicting 12-month mortality as TIMI risk score and a better discrimination performance in predicting 12-month stroke than TIMI risk score. Thus, it can serve as an additive tool in identifying high-risk patients that require aggressive management.

KeywordsSTEMI Diabetes mellitus Risk score CHA2DS2-VASc Prognosis Managed by Antonio Secchi.

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Autor: Bartosz Hudzik - Janusz Szkodziński - Michal Hawranek - Andrzej Lekston - Lech Poloński - Mariusz Gąsior

Fuente: https://link.springer.com/







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