[The predictive value of the CHA2DS2-VASc score for in-hospital outcomes in patients with acute myocardial infarction: China PEACE-retrospective acute myocardial infarction study].

Objectives: This study aimed to evaluate the predictive value of the CHA2DS2-VASc score for in-hospital outcomes of patients with acute myocardial infarction (AMI). Methods: Data of 23 728 patients from the China patient-centered Evaluative Assessment of cardiac Events (China PEACE)Retrospective Acute Myocardial Infarction Study were analyzed retrospectively. The patients were categorized into 3 groups according to the CHA2DS2-VASc scores: the low score group (score 1-3), the middle score group (score 4-6) and the high score group (score 7-9). The in-hospital outcomes included major adverse cardiovascular events (MACE), death, death or withdrawal from treatment, reinfarction, ischemic stroke,etc. The CHA2DS2-VASc score was incorporated into multivariate Cox regression analyses to determine its independent impact on in-hospital outcomes. Receiver operating Characteristic (ROC) curves were constructed, and the area under the curve (AUC) was used to evaluate the predictive value of the CHA2DS2-VASc score for in-hospital mortality and death or withdrawal from treatment, respectively. Results: The patients had a median age of 66 (56,75) years, and 30.7% of them were females. Patients with higher CHA2DS2-VASc scores had a higher in-hospital mortality and more in-hospital complications (all P<0.001). After adjustment of baseline covariates, the subjects in the high score group were associated with high risks of in-hospital mortality (OR=6.13, 95%CI 4.77-7.87, P<0.001), death or treatment withdrawal (OR=6.43, 95%CI 5.16-8.00, P<0.001) and MACE (OR=4.94, 95%CI 4.06-6.01, P<0.001). The AUCs of the CHA2DS2-VASc score were comparable with those of the mini-global registry of acute coronary events(mini-GRACE)score in evaluation of in-hospital mortality (0.699 vs. 0.696, P=0.752) and the death or treatment withdrawal risk (0.708 vs. 0.713, P=0.489). Conclusions: The CHA2DS2-VASc score is an independent predictor of in-hospital outcomes for patients with AMI. Its predictive value was comparable with the mini-GRACE score, which could be used as a simple tool for early and rapid outcome evaluation for AMI patients.目的： 评估CHA2DS2-VASc评分对急性心肌梗死（AMI）患者院内结局事件的预测价值。 方法： 回顾性分析冠心病医疗结果评价和临床转化研究（China PEACE）回顾性急性心肌梗死研究中23 728例AMI患者的病历信息，按CHA2DS2-VASc 评分分为低（0~3分）、中（4~6分）、高（7~9分）分值组。院内结局包括主要不良心血管事件、死亡、死亡或放弃治疗、再发心肌梗死、缺血性卒中等。采用多因素Cox回归分析CHA2DS2-VASc评分对AMI患者院内结局的影响。通过受试者工作特征（ROC）曲线，评估CHA2DS2-VASc评分对AMI患者院内死亡与死亡或放弃治疗的预测价值。 结果： 入组患者年龄66（56，75岁）岁，女性占30.7%。CHA2DS2-VASc评分高分值组患者院内结局事件发生率更高，基础疾病更多（P值均<0.001）；多因素logistic回归中，院内病死率（OR=6.13，95%CI 4.77~7.87，P<0.001）、院内死亡或放弃治疗率（OR=6.43，95%CI 5.16~8.00，P<0.001）、主要心血管事件发生率（OR=4.94，95%CI 4.06~6.01， P<0.001）明显高于其他两组。ROC曲线分析显示，无论院内病死率，还是死亡或放弃治疗率，CHA2DS2-VASc评分与简化版全球急性冠状动脉事件登记（global registry of acute coronary events，mini-GRACE）评分相比差异无统计学意义（ROC曲线下面积：0.699 与 0.696，P=0.752；0.708与 0.713，P=0.489）。 结论： CHA2DS2-VASc评分是一种有效预测AMI患者院内风险的评估工具，该评分操作简单，预测价值与mini-GRACE评分相当。.