Prognostic impact of renal dysfunction in patients with acute coronary syndrome—role beyond the CHA 2 DS 2 ‐VASc score: Data from Taiwan acute coronary syndrome full spectrum registry

Aim CHA 2 DS 2 ‐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 CHA 2 DS 2 ‐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, eGFR<60 mL/min per 1.73 m 2 ). 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 <  0.001). Renal dysfunction (eGFR<60 mL/min per 1.73 m 2 ) and CHA 2 DS 2 ‐VASc scores were both significant predictors of adverse events in multivariable regression analyses. Renal dysfunction can further stratify patients with CHA 2 DS 2 ‐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 <  0.001). A new scoring system (R‐CHA 2 DS 2 ‐VASc score) derived by assigning one more point for eGFR ≤ 60 mL/min per 1.73 m 2 to the CHA 2 DS 2 ‐VASc score could improve its predictive accuracy (area under the receiver operating curve, 0.70 vs. 0.66, P <  0.001). Conclusions Renal dysfunction is a significant risk factor of future adverse events in ACS patients and may improve the prognostic impact of the CHA 2 DS 2 ‐VASc score.