CHA₂DS₂-VASc Score for Predicting Recurrent Acute Coronary Syndrome and Heart Failure Following Acute Coronary Syndrome

Recurrent acute coronary syndrome (ACS) and heart failure (HF) are the leading causes of readmission and are associated with a significantly worse prognosis than the original episode. This study aimed to assess the utility of the CHA₂DS₂-VASc score in predicting these events in patients with ACS. We enrolled 2,213 patients (1,603 men; mean age, 69 years) hospitalized for ACS who survived for 1 year after discharge. The primary outcome was the composite of non-fatal recurrent ACS and HF hospitalization. During the 12-month follow-up, the primary outcome was observed in 81 patients (3.7%), comprising 44 patients with recurrent ACS events and 37 with HF admissions. Multivariate Cox regression analyses revealed that the CHA₂DS₂-VASc score was an independent predictor of the primary outcome and HF admission, regardless of atrial fibrillation (AF) status, and included patients treated with primary percutaneous coronary intervention (PCI). The optimal CHA₂DS₂-VASc score cutoff value for predicting non-fatal events was 4 points. Integration of the CHA₂DS₂-VASc score with the N-terminal pro-B-type natriuretic peptide level improved the predictive accuracy for HF admission, as evidenced by higher C-index and net reclassification improvement values (both p < 0.05). In conclusion, the CHA₂DS₂-VASc score clearly identified high-risk patients based on recurrent ACS or admission for HF among those with ACS, irrespective of the presence of AF, and those undergoing primary PCI.