Predictive role of CHA₂DS₂-VASc score in acute coronary syndrome patients and value of adding global longitudinal strain to CHA₂DS₂-VASc score.

Background: Future clinical management would be improved by accurate and early identification of ACS patients at high CV risk. In non-valvular atrial fibrillation patients, the prognostic risk of thromboembolism has been evaluated using CHA₂DS₂-VASc scores. It has recently been shown to assess the severity of CAD and foresee patient outcomes. Also, LV global longitudinal strain is an independent predictor of outcome. Our study aimed to determine the added value of LV longitudinal strain (GLS) to CHA₂DS₂-VASc in predicting the outcome and severity of CAD in patients with acute coronary syndrome (ACS).

Methods: A total of 577 patients with primary diagnosis of ACS were included between January and July 2021. All patients had evaluations based on history, clinical examination, 12-lead ECG, TTE, and coronary angiography. Six months follow-up had been provided to all patients.

Results: Syntax score was significantly higher among patients with high-risk CHA₂DS₂-VASc score (30.5 ± 6.1 vs. 17.34 ± 8.7 vs. 11.11 ± 8.2), p-value <0. 001. GLS was significantly lower among high SYNTAX score (-10.97 ± 2.68 vs. -12.61 ± 3.46 vs. -17.81 ± 2.89), p-value = 0.0001. There was a significant negative correlation between the CHA₂DS₂-VASc score and GLS. Moreover, adding GLS to CHA₂DS₂-VASc score significantly improved overall accuracy for the prediction of outcome and severity of CAD in ACS patients.

Conclusions: CHA₂DS₂-VASc score is an easy and simple parameter that can be used in predicting the severity of CAD & adverse clinical outcome in ACS patients and adding GLS to the CHA₂DS₂-VASc score significantly improved overall accuracy.