Usefulness of the CHADS2 Score for Prognostic Stratification of Patients With Acute Myocardial Infarction

•The CHADS2 score is easy to calculate at the bedside and includes clinical data that are routinely available in the coronary care unit.•The CHADS2 score provides significant discriminatory ability for predicting major adverse cardiovascular events in patients with acute myocardial infarction (AMI).•Compared with the Thrombolysis In Myocardial Infarction risk score and the Global Registry of Acute Coronary Events risk score, the CHADS2 score is simpler and more practical for predicting clinical outcome when applied to patients with AMI.•Use of the CHADS2 score is an acceptable method for risk stratification and prognosis of patients with AMI.

The Thrombolysis In Myocardial Infarction (TIMI) score and Global Registry of Acute Coronary Events (GRACE) score have been validated as predictors of major adverse cardiovascular events (MACE) in patients with acute myocardial infarction (AMI). This study was undertaken to determine whether the CHADS2 score had good accuracy for predicting clinical outcome in patients with AMI and to compare the discriminatory performance of the 3 risk scores (RSs). We calculated the TIMI RS, GRACE RS, and CHADS2 score for 747 consecutive patients with AMI. The study end point was the combined occurrence of MACE, including death, nonfatal myocardial infarction, and ischemic stroke. All patients were followed up for at least 3 years or until the occurrence of a major event. The area under the receiver operating characteristic curve was used to evaluate the predictive ability of each score at different time points. Higher CHADS2 scores were associated with adverse outcome at discharge and 1-year and 3-year follow-ups (chi-square test for linear trend, p <0.001). Both CHADS2 score and GRACE RS demonstrated better discrimination than TIMI RS in predicting 1-year and 3-year MACE (p <0.001). Multivariate Cox regression analysis revealed that the CHADS2 score was an independent predictor of future MACE in patients with AMI (hazard ratio 1.349, 95% confidence interval 1.196 to 1.522). In conclusion, the CHADS2 score provides potentially valuable prognostic information on clinical outcome when applied to patients with AMI.