Risk stratification of cardiovascular complications using CHA 2 DS 2 -VASc and CHADS 2 scores in chronic atherosclerotic cardiovascular disease.

Background The COMPASS (Cardiovascular Outcomes for People Using Anticoagulation Strategies) trial showed that rivaroxaban plus aspirin reduced major adverse cardiovascular events (MACE) in patients with chronic coronary artery disease (CAD) and/or peripheral artery disease (PAD). We explored whether CHA ₂ DS ₂ -VASc or CHADS ₂ scores, well-validated tools for assessing risk of thromboembolic events in atrial fibrillation, can identify vascular patients at highest risk of recurrent events who may derive greatest benefits of treatment. Methods Predictive accuracies of the CHA ₂ DS ₂ -VASc and CHADS ₂ scores for MACE, were assessed in this analysis of the COMPASS trial. Kaplan-Meier estimates of cumulative risk were used to compare the effects of rivaroxaban plus aspirin (n = 9152) with aspirin alone (n = 9126) according to risk scores. Results High CHA ₂ DS ₂ -VASc (6-9) or CHADS ₂ (3-6) scores were associated with over three times greater absolute risk of MACE compared with CHA ₂ DS ₂ -VASc score of 1-2 or CHADS ₂ score of 0. The effects of rivaroxaban plus aspirin compared with aspirin alone were consistent across CHA ₂ DS ₂ -VASc and CHADS ₂ score categories for MACE, bleeding and net clinical benefit, with greatest reduction in MACE observed in patients treated for 30 months with highest CHADS ₂ score (3-6) (hazard ratio = 0.67, 95% CI: 0.53-0.86, p = 0.0012, 25 events per 1000 patients prevented). Conclusion The CHA ₂ DS ₂ -VASc and CHADS ₂ scores can be used in patients with chronic CAD and/or PAD to identify patients who are at highest risk of MACE. Those identified at highest risk by CHADS ₂ scores had greatest benefit from dual pathway inhibition with rivaroxaban plus aspirin. Clinical Trial Registration: NCT01776424.
(Copyright © 2021. Published by Elsevier B.V.)