Predictive accuracy of CHA2DS2-VASc and HAS-BLED scores in patients without atrial fibrillation undergoing percutaneous coronary intervention and discharged on dual antiplatelet therapy

Background: The CHA(2)DS(2)-VASc and HAS-BLED are well-validated stroke risk prediction scores for atrial fibrillation (AF), but their role in risk stratification of major adverse cardiac events (MACEs) and major bleeding for non-AF patients undergoing percutaneous coronary intervention (PCI) is unknown. Methods: Consecutive patients without AF undergoing PCI at two Italian centers were analyzed with different measures of discrimination, net reclassification improvement and net prognostic benefit. MACE included all-cause death, myocardial infarction, destabilizing symptoms leading to hospitalization, and nonfatal stroke. Major bleeding was defined according to the TIMI classification. Results: Of 1437 subjects undergoing PCI, 1330 (mean age 63.6 +/- 10.9 years, 75.7% male) fulfilled the inclusion criteria. During 2.7 +/- 1.2 years of follow-up representing 3539 patient-years at risk, 187 patients had a MACE (5.3%/year) and 48 had a major bleeding (1.4%/year). The cumulative incidences of MACE were significantly stratified by both high CHA(2)DS(2)-VASc (P = 0.020) or HAS-BLED (P < 0.001) scores, whereas major bleeding episodes were not. The CHA(2)DS(2)-VASc and the HAS-BLED scores had similar C-statistics for MACE (0.56 vs 0.60; P = 0.52) and major bleeding (0.63 vs 0.60; P = 0.63). Compared with CHA(2)DS(2)-VASc, the HAS-BLED score more accurately reclassified events and no events both for MACE (NRI 8.21%) and major bleeding (NRI 6.85%). Conclusions: In patients without AF undergoing PCI and discharged on dual antiplatelet therapy, the HAS-BLED score performed better than the CHA(2)DS(2)-VASc for the prediction of MACE. Although both scores predict MACE, their discrimination was modest. Conversely, both scores did not significantly predict major bleeding in non-AF patients undergoing PCI. (C) 2015 Elsevier Ireland Ltd. All rights reserved.