CHA₂DS₂‐VASc score and clinical outcomes of patients with chest pain discharged from internal medicine wards following acute coronary syndrome rule‐out

Abstract

Background Chest‐pain patients deemed safe for discharge from internal medicine wards might still be at risk for adverse outcomes. Hypothesis CHA 2 DS 2 ‐VASc score improves risk stratification of low‐risk chest‐pain patients discharged after acute coronary syndrome (ACS) rule‐out. Methods We accessed medical records of patients who were admitted to internal medicine wards at a single medical center during 2010–2016 and discharged following an ACS rule‐out. Patients were classified according to CHA 2 DS 2 ‐VASc score: 0–1 (low), 2–3 (intermediate), >3 (high). Primary endpoint was occurrence of ACS at 1 year; 30‐day and 1‐year all‐cause mortality (ACM) were secondary outcomes. Results Of 12 449 patients, 7057 (57%) had low, 3781 (30%) intermediate, and 1611 (13%) high CHA 2 DS 2 ‐VASc scores. Compared with a low score, intermediate and high scores were associated with significantly increased risk for 1‐year ACS during the first year (OR: 2.89, 95% CI: 1.91–4.37, P < 0.01 and OR: 4.84, 95% CI: 3.02–7.74, P < 0.01, respectively). Each 1‐point increase in CHA 2 DS 2 ‐VASc was associated with a 37% increased risk for 1‐year ACS. A higher CHA 2 DS 2 ‐VASc score was associated with significantly higher 30‐day ACM. Hazard ratios for 30‐day ACM were 1.9 (95% CI: 1.1–3.4, P = 0.03) and 4.4 (95% CI: 2.4–7.9, P < 0.01) for intermediate and high CHA 2 DS 2 ‐VASc scores, respectively, compared with a low score. Each 1‐point increase in CHA 2 DS 2 ‐VASc score was associated with 43% increased risk for 30‐day mortality. Conclusions High CHA 2 DS 2 ‐VASc score (>3) was associated with adverse outcomes among chest‐pain patients discharged from internal medicine wards following ACS rule‐out.