Prognostic impact of renal dysfunction in patients with acute coronary syndrome—role beyond the CHA₂DS₂-VASc score: Data from Taiwan acute coronary syndrome full spectrum registry

Aim: CHA₂DS₂-VASc score has been proven to have great prognostic value in patients with acute coronary syndrome (ACS). We aimed to determine whether the addition of renal dysfunction in the CHA₂DS₂-VASc score would improve the prognostic impact of the scoring system to predict prognosis among ACS patients. Methods: A total of 3031 ACS patients were prospectively enrolled at 39 hospitals and followed for 1 year. The patients were divided into three groups based on estimated glomerular filtration rate (eGFR) (group 1, eGFR>90; group 2, eGFR between 60 and 90; and group 3, eGFR2). The occurrence of subsequent myocardial infarction (MI), stroke, or death was recorded. Results: As renal function progressively decreased from group 1 to 3, the patients were, respectively older and had higher incidence of comorbidity, worse Killip classification, and less evidence-based medical therapies. The rate of subsequent MI, stroke or death increased from 3.4% in group 1 to 7.4% in group 2 and 17.2% in group 3 (P 2) and CHA₂DS₂-VASc scores were both significant predictors of adverse events in multivariable regression analyses. Renal dysfunction can further stratify patients with CHA₂DS₂-VASc score of 0 or 1 into 3 groups with different adverse event rates (group 1, 3.0%; group 2, 4.1%; and group 3, 9.2%, P 2DS₂-VASc score) derived by assigning one more point for eGFR ≤ 60 mL/min per 1.73 m² to the CHA₂DS₂-VASc score could improve its predictive accuracy (area under the receiver operating curve, 0.70 vs. 0.66, P 2DS₂-VASc score.