CHA 2 DS 2 -VASc score and clinical outcomes of patients with chest pain discharged from internal medicine wards following acute coronary syndrome rule-out

• Published in: Clinical cardiology (Mahwah, N.J.) N.J.), 2018-04, Vol.41 (4), p.539-543
• Main Authors: Topaz, Guy, Haisraely, Ory, Shacham, Yacov, Beery, Gil, Shilo, Lotan, Kassem, Nuha, Pereg, David, Kitay-Cohen, Yona
• Format: Article
• Language: English
• Subjects: Acute Coronary Syndrome - complications; Acute Coronary Syndrome - diagnosis; Acute Coronary Syndrome - mortality; Adult; Aged; Angina Pectoris - diagnosis; Angina Pectoris - etiology; Angina Pectoris - mortality; Cause of Death; Chest Pain - diagnosis; Chest Pain - etiology; Chest Pain - mortality; Decision Support Techniques; Diagnosis, Differential; Electronic Health Records; Female; Hospital Departments; Humans; Internal Medicine; Male; Middle Aged; Patient Discharge; Predictive Value of Tests; Prognosis; Risk Assessment; Risk Factors; Time Factors
• ISSN: 0160-9289; 1932-8737
• DOI: 10.1002/clc.22925

Chest-pain patients deemed safe for discharge from internal medicine wards might still be at risk for adverse outcomes. CHA DS -VASc score improves risk stratification of low-risk chest-pain patients discharged after acute coronary syndrome (ACS) rule-out. 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 DS -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. Of 12 449 patients, 7057 (57%) had low, 3781 (30%) intermediate, and 1611 (13%) high CHA DS -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