الفهرس 
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Abstract
Cardiovascular diseases account for more than17 million deaths globally each year. It contributes to 30% of all deaths. Among them 80% occur in low and middle-income countries. This figure is expected to grow to 23.6 million by the year 2030. Coronary artery disease alone caused 7 million deaths worldwide in 2010 and it is increased by 35% since 1990.
Risk evaluation is important for the management of patients with NSTE-ACS. Current guidelines for the risk stratification of patients with NSTE-ACS recommend the use of (TIMI) or (GRACE) score.
Clinicians need simple, reliable, and quantitative tools to evaluate patients’ risks and recommend prevention strategies.
The CHA2DS2-VASc score is a clinical predictor used to evaluate the risk of cardiac thromboembolism in non valvular Atrial Fibrillation and to guide anti-thrombotic therapy. CHADS2 and CHA2DS2-VASc scores are widely used in clinical practice and include similar risk factors for the development of coronary artery disease (CAD). These scores have been demonstrated to have predictive value in terms of the risk of death after stroke, after coronary artery bypass grafting (CABG), and with stable CAD and acute coronary syndrome.
The aim of study was to evaluate the association of CHA2DS2-VASc-HS score with adverse in-hospital outcomes and its relation with LV global longitudinal strain (GLS) in patients with NSTEMI.
Our study included 100 patients who presented with NSTEMI and admitted to coronary care unit at Benha university hospitals from May, 2020 to May, 2021. The patients were selected from those admitted with typical chest discomfort at rest in the past 48 h in the absence of persistent ST-elevation on the electrocardiogram and presence of positive cardiac enzymes.
Patients with prior myocardial infarction, previous revascularization (PCI or CABG), valvular heart diseases, congenital heart diseases, cardiomyopathy, myocarditis, pericarditis, and significant co-morbidities were excluded.
The CHA2DS2-VASc-HS score was calculated for all study population.
All Patients were subjected to the following:
• Complete clinical work-up:
History taking: including age, gender, history of diabetes mellitus, hypertension, hyperlipidemia, cigarette smoking, family history of premature CAD, previous ischemic stroke or transient ischemic attack (TIA) and symptoms of heart failure.
Clinical examination: including heart rate, systolic blood pressure, diastolic blood pressure, signs of heart failure and PAD.
• Laboratory investigations: Lipid profile, complete blood count, serum creatinine, Troponin I .
• Conventional transthoracic echocardiography in the standard views :
2-D study : to assess (WMSI , EF by modified Simpson method, LVESD, LVEDV)
2D speckle tracking echocardiography: to assess GLPSS.
Then the in-hospital outcomes were observed and recorded. Outcome variables comprised of recurrent ischemia, heart failure, cardiogenic shock, significant arrhythmia and death. Overall adverse outcomes were defined as consisting of the occurrence of any one of a set of multiple outcomes.
The study showed that among the NSTEMI patients with CHA2DS2- VASc-HS >4 (group I), 16.7% developed heart failure, 11.7% suffered from recurrent ischemia, 10% developed cardiogenic shock, Only 1.7% developed significant arrhythmias and 3.3% died; while among patients with CHA2DS2-VASc-HS score< 4 (group II), 3.3%, 3.3% and 1.7% developed heart failure, recurrent ischemia and significant arrhythmia respectively.
We also observed that the total patients with adverse in- hospital outcomes in group I was 20%, while in group II was 3% and the difference was statistically significant.
So, CHA2DS2-VASc-HS scores can be used to predict the risk of clinical adverse events in patients with NSTEMI.
By identifying higher risk patients with CHA2DS2-VASc-HS score >4, we are able to pay special attention to them and formulate an optimized treatment strategy, which might reduce risks of subsequent adverse events.
In conclusion, our study demonstrated that patients with high CHA2DS2-VASc-HS score had more adverse in-hospital outcomes.