CHA2DS2-VASc score predicts periprocedural complications and mortality of percutaneous coronary intervention irrespective of atrial fibrillation: a systematic review and meta-analysis
Authors: Ananta M , Harmen F , Utami N P B S , Ongkojoyo E , Setiawan B , Perkasa I B 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Background
Periprocedural complications of Percutaneous Coronary Intervention (PCI) are dreaded as they negatively impact prognosis, but they are hard to predict especially in resource-limited settings. CHA2DS2-VASc Score, apart from predicting thromboembolic risk in atrial fibrillation, has been reported to be associated with several complications of PCI.

Purpose
We aimed to assess the predictive value of CHA2DS2-VASc score for periprocedural complications and mortality in Acute Coronary Syndrome (ACS) patients treated with PCI.

Methods
Systematic search of the literature was conducted through Pubmed and Embase for all articles published from inception until 24th September 2023. Studies were included if they were observational studies conducted in ACS patients who received PCI during index hospital stay and evaluated the value of CHA2DS2-VASc score to predict at least one outcome of interest. Studies were excluded if they only used modified CHA2DS2-VASc score or did not conduct a separate analysis for ACS patients.

Results
Out of 1,783 manually reviewed unique studies, 34 studies involving a total of 342,141 ACS patients were included. Only 2 studies exclusively included patients with atrial fibrillation. Random effect meta-analyses found a significant association between high CHA2DS2-VASc score and Contrast-Induced Nephropathy/CIN (11 studies; OR 5.35; 95%CI 3.56–8.03; I2=94%), no-reflow phenomenon (14 studies; OR 3.21; 95%CI 2.20–4.68; I2 = 91%), acute stent thrombosis (3 studies; OR 5.23; 95%CI 3.85–7.10; I2=0%), in-hospital all-cause mortality (9 studies; OR 3.25; 95%CI 1.65–6.44; I2=91%), in-hospital cardiovascular mortality (3 studies; 3.05; 95%CI 1.58–5.87; I2=38%), post-discharge all-cause mortality (4 studies; 3.35; 95%CI 2.24–5.02; I2=0%), and post-discharge cardiovascular mortality (3 studies; 3.65; 95%CI 2.65–5.01; I2=35%). The CHA2DS2-VASc score cut-off with the highest OR for each outcome was used in bivariate random-effects meta-analysis model for diagnostic test accuracy. CHA2DS2-VASc score cut-off of ≥4 is a good predictor of CIN/AKI (5 studies) with AUC 0.81 (0.77–0.84), sensitivity 0.70 (0.51–0.84), specificity of 0.81 (0.54–0.94), while CHA2DS2-VASc score cut-off of ≥2 is good for screening no-reflow phenomenon (5 studies) with AUC 0.70 (0.66–0.74), sensitivity 0.86 (0.56–0.97), specificity 0.44 (0.20–0.71), and for screening in-hospital all-cause mortality (5 studies) with AUC 0.77 (0.73–0.81), sensitivity 0.88 (0.77–0.94), and specificity 0.35 (0.19–0.55).

Conclusion
CHA2DS2-VASc score is a rapid, non-invasive, and easily measurable tool that provides a good prediction of CIN/AKI, as well as a useful screening tool for no-reflow phenomenon and in-hospital all-cause mortality in ACS patients who received PCI regardless of their atrial fibrillation diagnosis.CHA2DS2-VASc score cut-off 4 for CIN/AKICHA2DS2-VASc cut-off 2 for no-reflow