CHA2DS2-VASc and CHADS2 scores for risk stratification of major adverse cardiovascular events in the COMPASS trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Sen ◽  
A Tonkin ◽  
J Varigos ◽  
S Fonguh ◽  
S.D Berkowitz ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Clinical Benefit ◽  
Cardiovascular Events ◽  
Absolute Risk ◽  
Risk Scores ◽  
Major Adverse Cardiovascular Events ◽  
Funding Source ◽  
Chads2 Score ◽  
Artery Disease ◽  
Net Clinical Benefit

Abstract Background The COMPASS (Cardiovascular Outcomes for People Using Anticoagulation Strategies) trial demonstrated that the combination therapy of rivaroxaban and aspirin reduced major adverse cardiovascular events (MACE) compared to aspirin alone in patients with chronic coronary artery disease (CAD) and/or peripheral artery disease (PAD). Purpose We assessed whether the CHA2DS2-VASc (congestive heart failure (CHF), hypertension, age ≥75 years, diabetes, stroke/transient ischemic attack (TIA)/thromboembolism, vascular disease, age 65–75 years, and sex category) and CHADS2 (CHF, hypertension, age ≥75 years, diabetes, stroke/TIA) scores used to predict the risk of stroke in patients with atrial fibrillation, can be used identify vascular patients at highest risk of recurrent events who may derive greatest benefits of treatment. Methods In COMPASS patients, the predictive accuracy of CHA2DS2-VASc and CHADS2 scores were assessed for MACE, bleeding and net clinical benefit using Cox proportional hazards model. Kaplan-Meier estimates of cumulative risk and absolute risk differences were used to examine the effects of rivaroxaban plus aspirin compared with aspirin alone over 30 months according to risk score categories. Results In 27,395 participants with CAD and/or PAD, a high CHA2DS2-VASc score (6–9) was associated with 3 times greater absolute risk of MACE compared to a low score (1–2) (hazard ratio=3.39, 95% CI: 2.54–4.51, p<0.0001). The effects of combination therapy with rivaroxaban and aspirin on MACE, bleeding and net clinical benefit were consistent across CHA2DS2-VASc and CHADS2 score categories, with the greatest benefit in those with the highest risk scores (Figure 1). The greatest reduction in MACE with rivaroxaban and aspirin compared to aspirin only was observed in patients treated for 30 months with highest CHA2DS2-VASc score (6–9) (23 events per 1000 patients prevented) or highest CHADS2 score (3–6) (25 events per 1000 patients prevented). There was increased bleeding in patients with higher CHA2DS2-VASc and CHADS2 scores, but net clinical benefit was preserved across all risk categories and was greatest in those with the highest risk scores. Conclusion The CHA2DS2-VASc or CHADS2 scores can be used in patients with chronic CAD and/or PAD to identify patients who are at highest risk of MACE, and therefore likely to achieve the greatest benefit of dual pathway inhibition with the combination of rivaroxaban and aspirin compared with aspirin alone. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): This study was sponsored by Bayer AG.

Combination Use of Clopidogrel and Proton Pump Inhibitors Increases Major Adverse Cardiovascular Events in Patients With Coronary Artery Disease

2016 ◽  
Vol 22 (2) ◽  
pp. 142-152 ◽  
Author(s):  
Qiang Niu ◽  
Zhongsu Wang ◽  
Yong Zhang ◽  
Jiangrong Wang ◽  
Pei Zhang ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Combination Therapy ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Cardiovascular Events ◽  
Cochrane Library ◽  
Major Adverse Cardiovascular Events ◽  
Increased Risk ◽  
Artery Disease

Background: Published data indicated that combination use of clopidogrel and proton pump inhibitors (PPIs) may increase the incidence of major adverse cardiovascular events (MACEs). This has been a highly controversial topic for years. Design: The present study was performed to evaluate whether combination therapy of clopidogrel and PPIs is associated with increased risk of MACEs than with clopidogrel alone in patients with coronary artery disease. Methods: A systematic search of MEDLINE, EMBASE, and the Cochrane Library was conducted for studies recording the occurrence of MACEs in patients with exposure to concomitant use of clopidogrel and PPIs up to February 2015. Odds ratios (ORs) were combined using a random-effects model. Results: Patients receiving combination therapy with PPIs and clopidogrel were at significantly increased risk of MACEs (OR: 1.42; 95% confidence interval [CI]: 1.30-1.55). Adding a PPI to clopidogrel treatment was associated with a higher rate of MACE occurrence in rapid metabolizers (RMs, *1/*1) of CYP2C19 (OR: 1.42; 95% CI: 1.12-1.81), but there was no obviously increased rate (OR: 1.43; 95% CI: 0.89-2.28) in decreased metabolizers (with 1 or 2 loss-of-function allele). The increased risk of MACEs was similar in 4 classes of PPIs (omeprazole, lansoprazole, esomeprazole, and pantoprazole), but rabeprazole (OR: 1.03; 95% CI: 0.55-1.95) wasn’t. Conclusion: The combination use of clopidogrel and certain types of PPIs (omeprazole, lansoprazole, esomeprazole, pantoprazole) increases the risk of MACE in patients with coronary artery disease. Only in the RMs of CYP2C19, PPIs were associated with significantly increased MACE in patients coadministered with clopidogrel.

scholarly journals Management of High Blood Pressure in Those without Overt Cardiovascular Disease Utilising Absolute Risk Scores

2011 ◽  
Vol 2011 ◽  
pp. 1-3
Author(s):  
Mark R. Nelson
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Cardiovascular Events ◽  
Absolute Risk ◽  
Risk Scores ◽  
Cvd Risk ◽  
Adverse Cardiovascular Event ◽  
Single Measure ◽  
Usual Practice ◽  
Single Risk Factor

Increasing blood pressure has a continuum of adverse risk for cardiovascular events. Traditionally this single measure was used to determine who to treat and how vigorously. However, estimating absolute risk rather than measurement of a single risk factor such as blood pressure is a superior method to identify who is most at risk of having an adverse cardiovascular event such as stroke or myocardial infarction, and therefore who would most likely benefit from therapeutic intervention. Cardiovascular disease (CVD) risk calculators must be used to estimate absolute risk in those without overt CVD as physician estimation is unreliable. Incorporation into usual practice and limitations of the strategy are discussed.

scholarly journals Prognostic Value of Atherosclerotic Extent in Diabetic Patients with Nonobstructive Coronary Artery Disease

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Yipu Ding ◽  
Zinuan Liu ◽  
Guanhua Dou ◽  
Xia Yang ◽  
Xi Wang ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
High Risk ◽  
Prognostic Value ◽  
Risk Scores ◽  
Plaque Burden ◽  
Major Adverse Cardiovascular Events ◽  
Diabetic Patients ◽  
Nonobstructive Coronary Artery Disease ◽  
Artery Disease

Background and Objective. Atherosclerotic extent was proved to be associated with adverse cardiac events. Risk scores derived by coronary computed tomography angiography (CCTA) could identify high-risk group among patients with nonobstructive coronary artery disease (CAD), but the ability is still uncertain in the presence of diabetes mellitus (DM). The purpose of this study was to investigate the prognostic value of the atherosclerotic extent shown by CCTA in diabetic patients with nonobstructive CAD. Methods and Results. 813 DM patients (mean age 58.9 ± 9.9 years, 48.1% male) referred for CCTA due to suspected CAD in 2015-2017 were consecutively included. During a median follow-up of 31.77 months, 50 major adverse cardiovascular events (MACEs) (6.15%) were experienced, including 2 cardiovascular deaths, 14 nonfatal myocardial infarctions, 27 unstable anginas requiring hospitalization, and 7 strokes. Three groups were defined based on coronary stenosis combined with Leiden score as normal, nonobstructive Leiden < 5 , and nonobstructive Leiden ≥ 5 . Cox models were used to assess the prognosis of plaque burden within these groups. An incremental incidence of MACE rates was observed. After adjustment for age, gender, and presence of high-risk plaque, the group of Leiden ≥ 5 showed a higher risk than Leiden < 5 (HR: 1.88, 95% CI: 1.03-3.42, p = 0.039 ). Similar results were observed when segment involvement score (SIS) was used for sensitivity analysis. Conclusion. Atherosclerotic extent was associated with the prognosis of DM patients with nonobstructive coronary artery disease, highlighting the importance of better risk stratification and management.

scholarly journals Comparison of the Predictive Roles of Risk Scores of In-Hospital Major Adverse Cardiovascular Events in Patients with Non-ST Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention

2018 ◽  
Vol 27 (5) ◽  
pp. 459-465 ◽  
Author(s):  
Erdal Aktürk ◽  
Lütfü Aşkın ◽  
Hakan Taşolar ◽  
Serdar Türkmen ◽  
Hakan Kaya
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Cardiovascular Events ◽  
Coronary Intervention ◽  
Nonfatal Myocardial Infarction ◽  
Risk Scores ◽  
Major Adverse Cardiovascular Events ◽  
Syntax Score ◽  
Percutaneous Coronary ◽  
St Elevation

Objective: We evaluated the relationship between various risk scores (SYNTAX score [SS], SYNTAX score-II [SS-II], thrombolysis in myocardial infarction [TIMI] risk scores, and Global Registry of Acute Coronary Events [GRACE] risk scores) and major adverse cardiovascular events (MACE) in non-ST elevation myocardial infarction (NSTEMI) patients undergoing percutaneous coronary intervention (PCI). Subjects and Methods: The study population were selected from among 589 patients who underwent coronary angiography with a diagnosis of NSTEMI. TIMI and GRACE risk scores were calculated. SS and SS-II were calculated in all patients, and points were added according to the predefined algorithm, taking into account the other 6 clinical variables being monitored (age, sex, left ventricular ejection fraction, creatinine clearance, chronic obstructive pulmonary disease, and peripheral artery disease). Patients were classified into tertile 1 (SS < 22), tertile 2 (SS 23–32), and tertile 3 (SS > 32). Results: The group with high SS-II for PCI values in the risk scores were observed from tertile 1 to tertile 3 (from 25.0 ± 7.7 to 31.6 ± 9.4, p < 0.001, respectively). The SS-II score in patients with PCI was an independent predictor of MACE, in-hospital mortality, nonfatal myocardial infarction, and stent thrombosis (OR 1.082, 95% CI 1.036–1.131, p < 0.001). The overall MACE, in-hospital mortality, and nonfatal myocardial infarction rates were significantly higher in the high SS-II for PCI group (p < 0.001). Conclusion: TIMI and GRACE risk scores were able to predict MACE. In addition to these, SS-II was also able to predict in-hospital mortality, nonfatal myocardial infarction, and stent thrombosis.

scholarly journals Contemporary Review of Antithrombotic Therapy in Peripheral Artery Disease

2020 ◽  
Vol 13 (10) ◽  
Author(s):  
Connie N. Hess ◽  
Marc P. Bonaca
Keyword(s):  
Peripheral Artery Disease ◽  
Antithrombotic Therapy ◽  
Cardiovascular Events ◽  
Plaque Rupture ◽  
Risk Profile ◽  
Major Adverse Cardiovascular Events ◽  
Peripheral Artery ◽  
Different Populations ◽  
Artery Disease ◽  
Concomitant Coronary Artery Disease

Patients with peripheral artery disease (PAD) are at heightened risk for ischemic events related to atherothrombosis. Antithrombotic therapies can reduce the risk of atherothrombotic events but increase bleeding. Importantly, there is growing appreciation of the heterogeneity in risk profile and effect of antithrombotic therapies in different populations, including those with PAD. Further, patients with PAD are at risk for not only major adverse cardiovascular events but also major adverse limb events, and the drivers of risk for each are different. Within PAD populations, data from trials may be difficult to interpret due to differences among the studies with regards to patient population, clinical settings, and outcomes examined. The acute setting of peripheral revascularization which involves plaque rupture and endothelial disruption confers very high risk of major adverse limb events early postprocedure. Among patients with chronic PAD for whom the goal of antithrombotic therapy is secondary prevention, concomitant coronary artery disease, particularly with prior myocardial infarction, is associated with greatest risk for major adverse cardiovascular events, while prior peripheral revascularization or amputation is associated with greatest risk for major adverse limb events. Understanding of the potential impact of clinical setting and patient risk profile is important to guide evidence-based decisions regarding antithrombotic therapy in patients with PAD. In this article, we provide a contemporary review of data supporting the use of antithrombotic therapy in PAD, as well as a clinical framework for analysis and translation of these data into practice, highlighting areas in need of further investigation.

P5515Circulating galectin 1 is associated with severity of coronary artery disease and adverse cardiovascular events in patients undergoing coronary angiography

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R.-H Chou ◽  
Y.-W Lu ◽  
P.-H Huang
Keyword(s):  
Heart Failure ◽  
Stable Angina ◽  
Cardiovascular Events ◽  
Ventricular Remodeling ◽  
Major Adverse Cardiovascular Events ◽  
Syntax Score ◽  
Cardiac Inflammation ◽  
Hs Crp ◽  
Artery Disease ◽  
Stable Cad

Abstract Background Galectin-1, a β-galactoside-binding lectin, was reported to attenuate the cardiac inflammation and ventricular remodeling after AMI. Its role in stable CAD was not fully elaborated. This study aimed to identify the relationship between galectin-1 and severity of CAD in patients with stable angina. Methods Totally 834 subjects underwent elective CAG were enrolled. Pre-procedure galectin-1 and hsCRP concentrations were determined. Subjects were grouped into tertiles according to their galectin-1 concentrations. SYNTAX scores were calculated to evaluate the severity of CAD. All patients were followed until January 2019, or the occurrence of major adverse cardiovascular events (MACE). Results Patients with higher galectin-1 concentrations were older and had higher prevalence of hypertension, diabetes, heart failure, and with higher levels of hsCRP and STNYAX scores. Patients with the highest tertile of galectin-1 were associated with higher risk of MACE (Fig 1A), even after adjusting age, gender, hypertension, diabetes, hemoglobin, creatinine, and LVEF (aHR: 2.13, 95% CI: 1.04–4.33, p=0.038). Gelection-1 (AUC: 0.802) showed better discriminatory performance than hsCRP (AUC: 0.696) in prediction the incidence of MACE (Fig 1B). Table 1 Tertile 1 (n=278) Tertile 2 (n=278) Tertile 3 (n=278) P Age (years) 61.0 (54.8–71.0) 67.0 (60.0–75.0) 72.0 (61.0–80.3) <0.001 Male, n (%) 188 (67.6) 184 (66.2) 197 (70.9) 0.479 Hypertension, n (%) 153 (55.0) 185 (66.5) 219 (78.8) <0.001 Diabetes, n (%) 67 (24.1) 90 (32.4) 123 (44.2) <0.001 Heart failure, n (%) 10 (3.6) 8 (2.9) 44 (15.8) <0.001 Hemoglobin (g/dL) 13.5 (12.5–14.3) 13.4 (12.4–14.3) 12.3 (10.8–13.7) <0.001 Creatinine (mg/dL) 0.9 (0.8–1.1) 1.0 (0.9–1.2) 1.3 (1.1–1.9) <0.001 Hs-CRP (mg/dL) 0.1 (0.0–0.2) 0.1 (0.0–0.3) 0.2 (0.1–0.7) <0.001 Galectin 1 (ng/mL) 13.3 (10.2–14.7) 18.7 (17.4–20.5) 29.3 (25.5–38.5) <0.001 SYNTAX score 0.0 (0.0–5.0) 0.0 (0.0–7.0) 7.0 (0.0–16.1) <0.001 LVEF (%) 59.0 (54.6–62.2) 58.0 (52.0–63.0) 55.9 (49.0–60.9) 0.009 MACE: revascularization, n (%) 17 (6.1) 13 (4.7) 43 (15.5) <0.001 MACE: nonfatal MI, n (%) 1 (0.4) 1 (0.4) 7 (2.5) 0.018 MACE: nonfatal stroke, n (%) 0 (0.0) 1 (0.4) 2 (0.7) 0.367 MACE: death, n (%) 4 (1.4) 1 (0.4) 13 (4.7) 0.001 Conclusion Serum galectin-1 levels were associated with the severity of CAD and subsequent MACE in patients with stable angina. Acknowledgement/Funding This study was supported in part by research grants from the Taipei Veterans General Hospital and Taiwan Ministry of Science and Technology Academic E

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