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Original Research: CARDIOVASCULAR DISEASE |

Role of the CHADS2 Score in Acute Coronary SyndromesCHADS2 Score in Acute Coronary Syndromes: Risk of Subsequent Death or Stroke in Patients With and Without Atrial Fibrillation

Dritan Poçi, MD, PhD; Marianne Hartford, MD, PhD; Thomas Karlsson, MSc; Johan Herlitz, MD, PhD; Nils Edvardsson, MD, PhD; Kenneth Caidahl, MD, PhD; for the GRACE investigators
Author and Funding Information

From the Institute of Medicine (Drs Poçi, Hartford, Herlitz, and Edvardsson; and Mr Karlsson), Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg; the Department of Clinical Physiology (Dr Caidahl), Sahlgrenska University Hospital, Gothenburg; the Department of Cardiology (Dr Poçi), University Hospital Örebro, Örebro; and the Department of Molecular Medicine and Surgery (Dr Caidahl), Karolinska Institutet, Stockholm, Sweden.

Correspondence to: Dritan Poçi, MD, PhD, Department of Cardiology, University Hospital Örebro, 701 85 Örebro, Sweden; e-mail: dritan.poci@orebroll.se


For editorial comment see page 1375

Parts of this article have been presented at different scientific meetings during 2010: (Heart Rhythm 2010, Denver, Colorado, May 14, 2010, poster; Cardisotim 2010, Nice, France, June 18, 2010, oral presentation; and ESC Congress 2010, Stockholm, Sweden, August 29, 2010, poster).

Funding/Support: This study was supported by the Swedish Research Council (14231), the Swedish Heart and Lung Foundation, the Vardal Foundation, Gothenburg University, and the Göteborg Medical Society.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


© 2012 American College of Chest Physicians


Chest. 2012;141(6):1431-1440. doi:10.1378/chest.11-0435
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Background:  Atrial fibrillation (AF) is common in patients with acute coronary syndromes (ACS). We aimed to describe the value of the CHADS2 (congestive heart failure, hypertension, age ≥ 75 years, diabetes, prior stroke or transient ischemic attack) score as a risk assessment tool for mortality and stroke in patients with ACS, irrespective of the presence or absence of AF.

Methods:  Consecutive patients with ACS admitted to the coronary care unit were prospectively included in a risk stratification study. We calculated the CHADS2 scores from the data collected at admission, and all patients were followed until January 1, 2007, or death.

Results:  Of 2,335 patients with ACS in this study, 442 (age 71 ± 8 years, 142 women) had AF. Their mean CHADS2 score was 1.6 ± 1.4 vs 1.0 ± 1.1 in patients without AF (P < .0001). The all-cause mortality at 10 years was strongly associated with the CHADS2 score in patients with AF (hazard ratio [HR] and 95% CI per unit increase in the six-grade CHADS2 score, 1.21 [1.07-1.36]; P = .002), but the same association was also present in patients without AF (HR 1.38 [1.28-1.48], P < .0001), after adjustment for potential confounders. The more complicated GRACE (Global Registry of Acute Coronary Events) risk score provided a better prediction for short- and long-term mortality than the simpler CHADS2 score (P < .0001). Hospitalization for stroke was significantly associated with the CHADS2 score in patients without AF (but not in those with AF) after adjustment (HR 1.46 [1.27-1.68], P < .0001).

Conclusions:  In patients with ACS, AF is associated with poor prognosis. The CHADS2 score developed for AF has even greater prognostic value in patients who do not have AF, and it may help to identify patients with high risk for subsequent stroke or death and a need for optimization of risk-reducing treatment.

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