The prognostic role of the CHA₂DS₂-VASc score in patients with acute myocardial infarction receiving extracorporeal membrane oxygenation following out-of-hospital cardiac arrest

Onur Yıldırım; Necmettin Çolak; Yunus Nazlı; Ömer Zühtü Yöndem; Sercan Okutucu

Makale detayları

The prognostic role of the CHA₂DS₂-VASc score in patients with acute myocardial infarction receiving extracorporeal membrane oxygenation following out-of-hospital cardiac arrest

Yazarlar:

Onur Yıldırım | Necmettin Çolak | Yunus Nazlı | Ömer Zühtü Yöndem | Sercan Okutucu

Yayıncı:

MediHealth Academy Yayıncılık

Ana Başlıklar:

Kardiyoloji

Dergi:

Journal of Medicine and Palliative Care Vol.6 Issue 2, pp.116-123

Belge Tipi:

Makale

Yayın Tarihi:

3/2025

Belge Dili:

İngilizce

Document ID (Org No.):

2001343397

pISSN:

2717-7505

Anahtar kelimeler:

Özet:

 Aims: The CHA₂DS₂-VASc scoring system has been widely used for stroke risk stratification in patients with atrial fibrillation, yet evidence regarding its prognostic value in other critical settings remains limited. This study aimed to assess the utility of the CHA₂DS₂-VASc score in predicting mortality in patients with acute myocardial infarction AMI who received veno-arterial extracorporeal membrane oxygenation VA-ECMO support following out-of-hospital cardiac arrest. Methods: This retrospective study included 41 patients with AMI requiring VA-ECMO after OHCA. Baseline demographics, clinical characteristics, and prognostic scores, including CHA₂DS₂-VASc, SAVE Survival After Veno-Arterial ECMO, Glasgow Coma Scale GCS, and acute physiology and chronic health evaluation APACHE II were recorded. Patients were categorized into three risk groups based on the CHA₂DS₂-VASc score: low 0 points, moderate 1 point, and high 2 points. According to the SAVE score, patients were classified into five risk groups: class I 5 points, class II 14 points, class III 4 to 0 points, class IV 9 to 5 points, and class V 10 points. The primary outcome was in-hospital mortality. Results: The overall in-hospital mortality rate was 58.5. Patients with high risk group had a significantly higher mortality risk HR: 3.12, 95 CI: 1.28-7.63, p0.008. The SAVE score had the highest diagnostic performance, with a sensitivity of 81.2 and specificity of 76.5 AUC0.80. CHA₂DS₂-VASc AUC0.74 and APACHE II AUC0.72 also demonstrated good predictive performance. While CHA₂DS₂-VASc maintained a balanced sensitivity 70.8 and specificity 64.7, APACHE II had higher sensitivity 75.7 but lower specificity 58.8. GCS demonstrated the lowest diagnostic performance AUC0.68. Conclusion: While the SAVE score, a risk model specifically designed for VA-ECMO, provides a strong prognostic evaluation, the CHA₂DS₂-VASc score could be a simple and easily applicable tool for early risk stratification in this high-risk population.

 Aims: The CHA₂DS₂-VASc scoring system has been widely used for stroke risk stratification in patients with atrial fibrillation, yet evidence regarding its prognostic value in other critical settings remains limited. This study aimed to assess the utility of the CHA₂DS₂-VASc score in predicting mortality in patients with acute myocardial infarction AMI who received veno-arterial extracorporeal membrane oxygenation VA-ECMO support following out-of-hospital cardiac arrest. Methods: This retrospective study included 41 patients with AMI requiring VA-ECMO after OHCA. Baseline demographics, clinical characteristics, and prognostic scores, including CHA₂DS₂-VASc, SAVE Survival After Veno-Arterial ECMO, Glasgow Coma Scale GCS, and acute physiology and chronic health evaluation APACHE II were recorded. Patients were categorized into three risk groups based on the CHA₂DS₂-VASc score: low 0 points, moderate 1 point, and high 2 points. According to the SAVE score, patients were classified into five risk groups: class I 5 points, class II 14 points, class III 4 to 0 points, class IV 9 to 5 points, and class V 10 points. The primary outcome was in-hospital mortality. Results: The overall in-hospital mortality rate was 58.5. Patients with high risk group had a significantly higher mortality risk HR: 3.12, 95 CI: 1.28-7.63, p0.008. The SAVE score had the highest diagnostic performance, with a sensitivity of 81.2 and specificity of 76.5 AUC0.80. CHA₂DS₂-VASc AUC0.74 and APACHE II AUC0.72 also demonstrated good predictive performance. While CHA₂DS₂-VASc maintained a balanced sensitivity 70.8 and specificity 64.7, APACHE II had higher sensitivity 75.7 but lower specificity 58.8. GCS demonstrated the lowest diagnostic performance AUC0.68. Conclusion: While the SAVE score, a risk model specifically designed for VA-ECMO, provides a strong prognostic evaluation, the CHA₂DS₂-VASc score could be a simple and easily applicable tool for early risk stratification in this high-risk population.

 Aims: The CHA₂DS₂-VASc scoring system has been widely used for stroke risk stratification in patients with atrial fibrillation, yet evidence regarding its prognostic value in other critical settings remains limited. This study aimed to assess the utility of the CHA₂DS₂-VASc score in predicting mortality in patients with acute myocardial infarction AMI who received veno-arterial extracorporeal membrane oxygenation VA-ECMO support following out-of-hospital cardiac arrest. Methods: This retrospective study included 41 patients with AMI requiring VA-ECMO after OHCA. Baseline demographics, clinical characteristics, and prognostic scores, including CHA₂DS₂-VASc, SAVE Survival After Veno-Arterial ECMO, Glasgow Coma Scale GCS, and acute physiology and chronic health evaluation APACHE II were recorded. Patients were categorized into three risk groups based on the CHA₂DS₂-VASc score: low 0 points, moderate 1 point, and high 2 points. According to the SAVE score, patients were classified into five risk groups: class I 5 points, class II 14 points, class III 4 to 0 points, class IV 9 to 5 points, and class V 10 points. The primary outcome was in-hospital mortality. Results: The overall in-hospital mortality rate was 58.5. Patients with high risk group had a significantly higher mortality risk HR: 3.12, 95 CI: 1.28-7.63, p0.008. The SAVE score had the highest diagnostic performance, with a sensitivity of 81.2 and specificity of 76.5 AUC0.80. CHA₂DS₂-VASc AUC0.74 and APACHE II AUC0.72 also demonstrated good predictive performance. While CHA₂DS₂-VASc maintained a balanced sensitivity 70.8 and specificity 64.7, APACHE II had higher sensitivity 75.7 but lower specificity 58.8. GCS demonstrated the lowest diagnostic performance AUC0.68. Conclusion: While the SAVE score, a risk model specifically designed for VA-ECMO, provides a strong prognostic evaluation, the CHA₂DS₂-VASc score could be a simple and easily applicable tool for early risk stratification in this high-risk population.

 Amaç: CHA₂DS₂-VASc skorlama sistemi, atriyal fibrilasyonu olan hastalarda inme riskini sınıflandırmak için yaygın olarak kullanılmaktadır. Ancak, bu skorun diğer kritik klinik durumlarda prognostik değerine ilişkin kanıtlar sınırlıdır. Bu çalışma, hastane dışı kardiyak arrest OHCA sonrası veno-arteriyel ekstrakorporeal membran oksijenasyonu VA-ECMO desteği alan akut miyokard enfarktüsü AMI hastalarında CHA₂DS₂-VASc skorunun mortaliteyi öngörmedeki etkinliğini değerlendirmeyi amaçladı. Yöntemler: Bu retrospektif çalışmaya, OHCA sonrası VA-ECMO gerektiren 41 AMI hastası dahil edildi. Hastaların başlangıçtaki demografik özellikleri, klinik verileri ve CHA₂DS₂-VASc, SAVE Veno-Arteriyel ECMO Sonrası Hayatta Kalma, Glasgow Koma Skalası GCS ve Akut Fizyoloji ve Kronik Sağlık Değerlendirmesi APACHE II gibi prognostik skorları kaydedildi. CHA₂DS₂-VASc skoruna göre hastalar üç risk grubuna ayrıldı: düşük 0 puan, orta 1 puan ve yüksek 2 puan. SAVE skoruna göre ise hastalar beş risk sınıfına ayrıldı: Sınıf I 5 puan, Sınıf II 14 puan, Sınıf III 4 ila 0 puan, Sınıf IV 9 ila 5 puan ve Sınıf V 10 puan. Birincil sonuç ölçütü hastane içi mortaliteydi. Bulgular: Genel hastane içi mortalite oranı 58,5 olarak bulundu. Yüksek risk grubundaki hastalarda mortalite riski anlamlı derecede yüksekti HR: 3,12, 95 CI: 1,28-7,63, p  0,008. En yüksek tanısal performans SAVE skoruna aitti duyarlılık: 81,2, özgüllük: 76,5, AUC  0,80. CHA₂DS₂-VASc AUC  0,74 ve APACHE II AUC  0,72 de iyi bir öngörü performansı gösterdi. CHA₂DS₂-VASc skoru dengeli bir duyarlılık 70,8 ve özgüllük 64,7 sergilerken, APACHE II daha yüksek duyarlılık 75,7 ancak daha düşük özgüllük 58,8 gösterdi. GCS ise en düşük tanısal performansa sahipti AUC  0,68. Sonuç: VA-ECMO için özel olarak tasarlanmış bir risk modeli olan SAVE skoru güçlü bir prognostik değerlendirme sağlarken, CHA₂DS₂-VASc skoru bu yüksek riskli hasta grubunda erken risk sınıflandırması için basit ve kolay uygulanabilir bir araç olabilir.

Makale detayları

The prognostic role of the CHA₂DS₂-VASc score in patients with acute myocardial infarction receiving extracorporeal membrane oxygenation following out-of-hospital cardiac arrest

Yazarlar:

Onur Yıldırım | Necmettin Çolak | Yunus Nazlı | Ömer Zühtü Yöndem | Sercan Okutucu

Yayıncı:

MediHealth Academy Yayıncılık

Ana Başlıklar:

Kardiyoloji

Dergi:

Journal of Medicine and Palliative Care Vol.6 Issue 2, pp.116-123

Belge Tipi:

Makale

Yayın Tarihi:

3/2025

Belge Dili:

İngilizce

Document ID (Org No.):

2001343397

pISSN:

2717-7505

CHA2DS2-VASc score

extracorporeal membrane oxygenation

cardiogenic shock

mortalityCHA₂DS₂-VASc skoru

ekstrakorporeal membran oksijenasyonu

kardiyojenik şok

mortalite

Sayı

Makale detayları

Yazarlar: Onur Yıldırım | Necmettin Çolak | Yunus Nazlı | Ömer Zühtü Yöndem | Sercan Okutucu

Yayıncı: MediHealth Academy Yayıncılık

Ana Başlıklar: Kardiyoloji

Dergi: Journal of Medicine and Palliative Care Vol.6 Issue 2, pp.116-123

Belge Tipi: Makale

Yayın Tarihi: 3/2025

Belge Dili: İngilizce

Document ID (Org No.): 2001343397

pISSN: 2717-7505

Sayı

Yazarlar:

Onur Yıldırım | Necmettin Çolak | Yunus Nazlı | Ömer Zühtü Yöndem | Sercan Okutucu

Yayıncı:

MediHealth Academy Yayıncılık

Ana Başlıklar:

Kardiyoloji

Dergi:

Journal of Medicine and Palliative Care Vol.6 Issue 2, pp.116-123

Belge Tipi:

Makale

Yayın Tarihi:

3/2025

Belge Dili:

İngilizce

Document ID (Org No.):

2001343397

pISSN:

2717-7505