Int J Med Sci 2021; 18(1):276-283. doi:10.7150/ijms.49018

Research Paper

Using CHADS2, R2CHADS2, CHA2DS2-VASc score for mortality prediction in patients with abnormal low and high ankle-brachial index

Nai-Yu Chi1,4, Ho-Ming Su1,2,3, Wen-Hsien Lee1,2,3, Wei-Chung Tsai1,2, Ying-Chih Chen1,3, Tzu-Chieh Lin1,4, Ye-Hsu Lu1, Chee-Siong Lee1,2, Tsung-Hsien Lin1,2, Wen-Ter Lai1,2, Sheng-Hsiung Sheu1,2, Po-Chao Hsu1,2✉

1. Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
2. Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
3. Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan.
4. Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.

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Citation:
Chi NY, Su HM, Lee WH, Tsai WC, Chen YC, Lin TC, Lu YH, Lee CS, Lin TH, Lai WT, Sheu SH, Hsu PC. Using CHADS2, R2CHADS2, CHA2DS2-VASc score for mortality prediction in patients with abnormal low and high ankle-brachial index. Int J Med Sci 2021; 18(1):276-283. doi:10.7150/ijms.49018. Available from https://www.medsci.org/v18p0276.htm

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Abstract

Abnormal low and high ankle brachial index (ABI) is regarded as peripheral artery disease (PAD) which has extremely high morbidity and mortality. How to identify high-risk PAD patients with increased mortality is very important to improve the outcome. CHADS2, R2CHADS2, and CHA2DS2-VASc score are clinically useful scores to evaluate the annual risk of stroke in patients with atrial fibrillation. However, there was no literature discussing the usefulness of these scores for cardiovascular (CV) and all-cause mortality prediction in the patients with abnormal ABI. This longitudinal study enrolled 195 patients with abnormal low (< 0.9) and high ABI (> 1.3). CHADS2, R2CHADS2, and CHA2DS2-VASc score were calculated for each patient. CV and all-cause mortality data were collected for outcome prediction. The median follow-up to mortality was 90 months. After multivariate analysis, CHADS2, R2CHADS2, and CHA2DS2-VASc score were significant predictors of CV and all-cause mortality (all P < 0.001). CHA2DS2-VASc score had a better additive predictive value than CHADS2 and R2CHADS2 score for CV mortality prediction. R2CHADS2 and CHA2DS2-VASc score had better additive predictive values than CHADS2 score for all-cause mortality prediction. In conclusion, our study is the first study to investigate the usefulness of CHADS2, R2CHADS2, and CHA2DS2-VASc score for mortality prediction in patients with abnormal ABI. Our study showed all three scores are significant predictors for CV and all-cause mortality although there are some differences between the scores. Therefore, using the three scoring systems may help physicians to identify the high-risk PAD patients with increased mortality.

Keywords: all-cause mortality, cardiovascular mortality, CHADS2 score, CHA2DS2-VASc score, chronic kidney disease, R2CHADS2 score