CHA₂DS₂-VASc score and clinical outcomes of patients with chest pain discharged from internal medicine wards following acute coronary syndrome rule-out

Background: Chest-pain patients deemed safe for discharge from internal medicine wards might still be at risk for adverse outcomes. Hypothesis: CHA₂DS₂-VASc score improves risk stratification of low-risk chest-pain patients discharged after acute coronary syndrome (ACS) rule-out. Methods: We accessed medical records of patients who were admitted to internal medicine wards at a single medical center during 2010–2016 and discharged following an ACS rule-out. Patients were classified according to CHA₂DS₂-VASc score: 0–1 (low), 2–3 (intermediate), >3 (high). Primary endpoint was occurrence of ACS at 1 year; 30-day and 1-year all-cause mortality (ACM) were secondary outcomes. Results: Of 12 449 patients, 7057 (57%) had low, 3781 (30%) intermediate, and 1611 (13%) high CHA₂DS₂-VASc scores. Compared with a low score, intermediate and high scores were associated with significantly increased risk for 1-year ACS during the first year (OR: 2.89, 95% CI: 1.91–4.37, P < 0.01 and OR: 4.84, 95% CI: 3.02–7.74, P < 0.01, respectively). Each 1-point increase in CHA₂DS₂-VASc was associated with a 37% increased risk for 1-year ACS. A higher CHA₂DS₂-VASc score was associated with significantly higher 30-day ACM. Hazard ratios for 30-day ACM were 1.9 (95% CI: 1.1–3.4, P = 0.03) and 4.4 (95% CI: 2.4–7.9, P < 0.01) for intermediate and high CHA₂DS₂-VASc scores, respectively, compared with a low score. Each 1-point increase in CHA₂DS₂-VASc score was associated with 43% increased risk for 30-day mortality. Conclusions: High CHA₂DS₂-VASc score (>3) was associated with adverse outcomes among chest-pain patients discharged from internal medicine wards following ACS rule-out.