Prediction of new onset atrial fibrillation in patients with acute coronary syndrome undergoing percutaneous coronary intervention using the C2HEST and mC2HEST scores: A report from the multicenter REALE-ACS registry
NOAF may complicate ACS course, but the prediction of NOAF is still challenging.
•
C2HEST and mC2HEST scores have been proposed to predict NOAF in general population.
•
C2HEST and mC2HEST score showed good accuracy in predicting NOAF in ACS patients.
•
Simple clinical scores may be useful to detect ACS patients at higher risk of NOAF.
Abstract
Background
New onset atrial fibrillation (NOAF) is associated with worse clinical outcomes after acute coronary syndrome (ACS). Identification of ACS patients at risk of NOAF remains challenging. To test the value of the simple C2HEST score for predicting NOAF in patients with ACS.
Methods
We studied patients from the prospective ongoing multicenter REALE-ACS registry of patients with ACS. NOAF was the primary endpoint of the study. The C2HEST score was calculated as coronary artery disease or chronic obstructive pulmonary disease (1 point each), hypertension (1 point), elderly (age ≥ 75 years, 2 points), systolic heart failure (2 points), thyroid disease (1 point). We also tested the mC2HEST score.
Results
We enrolled 555 patients (mean age 65.6 ± 13.3 years; 22.9% women), of which 45 (8.1%) developed NOAF. Patients with NOAF were older (p < 0.001) and had more prevalent hypertension (p = 0.012), chronic obstructive pulmonary disease (p < 0.001) and hyperthyroidism (p = 0.018). Patients with NOAF were more frequently admitted with STEMI (p < 0.001), cardiogenic shock (p = 0.008), Killip class ≥2 (p < 0.001) and had higher mean GRACE score (p < 0.001). Patients with NOAF had a higher C2HEST score compared with those without (4.2 ± 1.7 vs 3.0 ± 1.5, p < 0.001). A C2HEST score > 3 was associated with NOAF occurrence (odds ratio 4.33, 95% confidence interval 2.19–8.59, p < 0.001). ROC curve analysis showed good accuracy of the C2HEST score (AUC 0.71, 95%CI 0.67–0.74) and mC2HEST score (AUC 0.69, 95%CI 065–0.73) in predicting NOAF.
Conclusions
The simple C2HEST score may be a useful tool to identify patients at higher risk of developing NOAF after presentation with ACS.
Graphical abstract
C2HEST score for prediction of NOAF in ACS patients. CAD: coronary artery disease; COPD: chronic obstructive pulmonary disease; NOAF: new onset atrial fibrillation; OR: odds ratio.
