CHA2DS2-VASC Score as a Predictor of Coronary Artery Disease: A Cross Sectional Observational Study

Main Article Content

Mohamed Magdy Shehata
Hanan Kamel Kassem
Ibtsam Khairat Ibrahim
Inas Elsayed Deraz


Background: The CHA2Ds2-VASC was was revealed to be a predictor for thromboembolism event in patients who do not have atrial fibrillation or who have supra ventricular arrhythmia. The aim of this work was to evaluate the role of CHA2DS2 – VASC score in prediction of coronary artery disease.

Methods: This cross sectional observational study included 150 patients underwent coronary angiography for diagnosis and treatment of CAD. There were 59 patients with ACS (including STEMI and Non-STEMI) and 91 patients with no ACS. All patients were subjected to complete history taking, clinical, general examination and local cardiac examination. Standard 12-lead ECG was obtained within 10 minutes of first medical contact (FMC) according to ESC guidelines. Baseline laboratory tests were done including serum creatinine, INR, hemoglobin, platelets, cholesterol and triglycerides. Arterial coronary angiography (Femoral approach), right and left coronary imaging and echocardiographs were performed.

Results: The incidence of HTN, CHF, DM and Vascular disease was statistically significantly higher in the cases with ACS as compared with the cases with no ACS. The total mean Gensini score was significantly higher in the cases with ACS as compared with the cases with no ACS. There was a statistically significantly strong positive correlation between CHA2DS2‐VASc Score and Gensini score. The best cut-off point of CHA2DS2‐VASc Score to differentiate between cases with ACS and no ACS WAS > 2 with 79.7% sensitivity and 56% specificity. With univariate regression analysis, increasing age, CHF, DM, previous stroke, vascular disease and increasing CHADS-VASC score were reported as risk factors for vessel affection, however with multivariate regression analysis CHF, DM and increasing CHADS-VASC score were shown as independent risk factors of vessel affection

Conclusions: CHA2DS2-VASc score could be utilized as a useful diagnostic and predictor tool in cases with CAD. Patients with higher CHA2DS2-VASc scores had higher risks of cardiovascular disease severity.

CHA2DS2-VASC score, coronary artery disease, predictor

Article Details

How to Cite
Shehata, M. M., Kassem, H. K., Ibrahim, I. K., & Deraz, I. E. (2021). CHA2DS2-VASC Score as a Predictor of Coronary Artery Disease: A Cross Sectional Observational Study. Cardiology and Angiology: An International Journal, 10(2), 10-19.
Original Research Article


Fihn SD, Blankenship JC, Alexander KP, Bittl JA, Byrne JG, Fletcher BJ, et al. ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2014;130:1749-67.

Tanna MS, Messerli FH, Bangalore S. Stable coronary artery disease: are there therapeutic benefits of heart rate lowering? Journal of hypertension. 2019;37:1112-8.

Amsterdam EA, Wenger NK, Brindis RG, Casey DE, Ganiats TG, Holmes DR, et al. AHA/ACC guideline for the management of patients with non–ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology. 2014;64:e139-e228.

Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). European heart journal. 2016;37:267-315.

Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Fourth universal definition of myocardial infarction. Journal of the American College of Cardiology. 2018;72:2231-64.

Levine GN, Bittl JA. Focused update on primary percutaneous coronary intervention for patients with ST-elevation myocardial infarction. JAMA cardiology. 2016;1:226-7.

Antman EM, Armstrong PW, Green LA, Halasyamani LK, Hochman JS, Krumholz HM, et al. 2007 focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction. Journal of the American College of Cardiology. 2008;51:210-47.

Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, et al. 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Catheterization and Cardiovascular Interventions. 2012;79:453-95.

Trikalinos TA, Alsheikh-Ali AA, Tatsioni A, Nallamothu BK, Kent DM. Percutaneous coronary interventions for non-acute coronary artery disease: a quantitative 20-year synopsis and a network meta-analysis. The Lancet. 2009;373:911-8.

Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest. 2010;137:263-72.

Guerra F, Scappini L, Maolo A, Campo G, Pavasini R, Shkoza M, et al. CHA2DS2-VASc risk factors as predictors of stroke after acute coronary syndrome: A systematic review and meta-analysis. European Heart Journal: Acute Cardiovascular Care. 2018;7:264-74.

Paoletti Perini A, Bartolini S, Pieragnoli P, Ricciardi G, Perrotta L, Valleggi A, et al. CHADS2 and CHA2DS2-VASc scores to predict morbidity and mortality in heart failure patients candidates to cardiac resynchronization therapy. Europace. 2014;16:71-80.

Bozbay M, Uyarel H, Cicek G, Oz A, Keskin M, Murat A, et al. CHA2DS2-VASc score predicts in-hospital and long-term clinical outcomes in patients with ST-segment elevation myocardial infarction who were undergoing primary percutaneous coronary intervention. Clinical and Applied Thrombosis/Hemostasis. 2017;23:132-8.

Cicek G, Yıldırım E. CHA2DS2-VASc score predicts contrast-induced nephro- pathy in patients with ST-segment elevation myocardial infarction, who have undergone primary percutaneous coronary intervention. Kardiologia polska. 2018;76:91.

Odum LE, Cochran KA, Aistrope DS, Snella KA. The CHADS 2 versus the New CHA 2 DS 2‐VAS c Scoring Systems for Guiding Antithrombotic Treatment of Patients with Atrial Fibrillation: Review of the Literature and Recommendations for Use. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 2012;32:285-96.

Aronis KN, Sahin-Efe A, Chamberland JP, Spiro III A, Vokonas P, Mantzoros CS. Chemerin levels as predictor of acute coronary events: a case–control study nested within the veterans affairs normative aging study. Metabolism. 2014;63:760-6.

Ciftci O, Yilmaz KC, Karacaglar E, Yilmaz M, Ozin B, Muderrisoglu IH. The Novel CHA2DS2-VASC-FSH Score is Predictive of Severe Coronary Artery Disease on Coronary Angiography in Patients with Atrial Fibrillation and Unstable Symptoms. The Eurasian journal of medicine. 2019;51:165.

Al-Shorbagy AN, Al-Cekelly MM, Dwedar AA-s, Soliman MH. The Predictive Value of Newly Defined CHA2DS2-VASC-HSF Score for Severity of Coronary Artery Disease in Non ST Segment Elevation Myocardial Infarction. Zagazig University Medical Journal. 2018;24:289-96.

Ji Q, Lin Y, Liang Z, Yu K, Liu Y, Fang Z, et al. Chemerin is a novel biomarker of acute coronary syndrome but not of stable angina pectoris. Cardiovascular diabetology. 2014;13:145.

Donal E, Lund LH, Oger E, Hage C, Persson H, Reynaud A, et al. Baseline characteristics of patients with heart failure and preserved ejection fraction included in the Karolinska Rennes (KaRen) study. Archives of cardiovascular diseases. 2014;107:112-21.

Abohammar S, ElSaidy MA, Fathalla D, Aldosarri M. Baseline characteristics of patients with heart failure and preserved ejection fraction at admission with acute heart failure in Saudi Arabia. The Egyptian Heart Journal. 2017;69:21-8.

Can U, Yerlikaya FH, Toker A, Arıbaş A, Akbuğa K. Serum Level of suPAR and YKL-40, a New Biomarker in Patients with Acute Myocardial Infarction? Acta Med Anatol. 2015;3:137-43.

Chua S-K, Lo H-M, Chiu C-Z, Shyu K-G. Use of CHADS 2 and CHA 2 DS 2-VASc scores to predict subsequent myocardial infarction, stroke, and death in patients with acute coronary syndrome: data from Taiwan acute coronary syndrome full spectrum registry. PloS one. 2014;9:e111167.

Alhaithami AS, Wadie MM, Wafa AA, Yossof MA, editors. Study of the CHA2DS2-VASc score in acute coronary syndrome. Scientific Sessions SCAI; 2019.

Cetin M, Cakici M, Zencir C, Tasolar H, Baysal E, Balli M, et al. Prediction of coronary artery disease severity using CHADS2 and CHA2DS2-VASc scores and a newly defined CHA2DS2-VASc-HS score. The American journal of cardiology. 2014;113:950-6.

Barman HA, Kahyaoglu S, Durmaz E, Atici A, Gulsen K, Tugrul S, et al. The CHADS-VASc score is a predictor of no-reflow in patients with non-ST-segment elevation myocardial infarction. Coronary Artery Disease. 2020;31:7-12.

Uysal OK, Turkoglu C, Duran M, Kaya MG, Sahin DY, Gur M, et al. Predictive value of newly defined CHA2DS2-VASc-HSF score for severity of coronary artery disease in ST segment elevation myocardial infarction. Kardiologia polska. 2016;74:954-60.