The CHADS2 and CHA2DS2-VASc scores predict adverse vascular function, ischemic stroke and cardiovascular death in high-risk patients without atrial fibrillation: Role of incorporating PR prolongation

Abstract

Objectives: To investigate whether the CHADS2 and CHA2DS2-VASc scores have clinical utility for prediction of adverse vascular function and vascular dysfunction-mediated incident cardiovascular (CV) events among high-risk patients without atrial fibrillation (AF), and the additional value of incorporating PR prolongation to the scores. Methods: We analyzed 579 high-risk CV outpatients without clinical AF in a prospective cohort for new-onset ischemic stroke, myocardial infarction (MI), congestive heart failure (CHF), and CV death. Brachial flow-mediated dilation (FMD) and nitroglycerin-mediated dilatation (NMD), carotid intima-media thickness (IMT) and pulse wave velocity (PWV) were determined. Results: Baseline CHADS2 score was associated with lower FMD (Pearson r=-0.16, P<0.001) and NMD (r=-0.17, P<0.001), higher carotid IMT (r=0.30, P<0.001) and PWV (r=0.35, P<0.001; similar for CHA2DS2-VASc score: All P<0.05). After follow-up of 63±11 months, 82 patients (14.2%) developed combined CV endpoint. ROC curve analysis showed that both CHADS2 and CHA2DS2-VASc scores were predictors for ischemic stroke (C-Statistic: CHADS2 0.70, P=0.004; CHA2DS2-VASc 0.68, P=0.010), MI (CHADS2 0.63, P=0.030; CHA2DS2-VASc 0.70, P=0.001), and CV death (CHADS2 0.63, P=0.022; CHA2DS2-VASc 0.65, P=0.011). Higher CHADS2 score was associated with reduced event-free survival from combined CV endpoints (log-rank=16.7, P<0.001) with differences potentiated if stratified by CHA2DS2-VASc score (log-rank=29.2, P<0.001). Incorporating PR prolongation, the CHA2DS2-VASc-PR score achieved the highest C-Statistic for CV death prediction (0.70, P<0.001) superior to the CHADS2 score (chi-square: 12.1, P=0.0005). Conclusions: The CHADS2 and CHA2DS2-VASc predict vascular dysfunction and cardiovascular events in high-risk CV patients without clinical AF, with further improved performance incorporating PR prolongation. © 2014 Elsevier Ireland Ltd.