Predictive Value of CHA₂DS₂-VASc Score for Severity of Coronary Artery Disease in Acute Coronary Syndrome

Abstract

Background: Early identification of complex coronary artery disease (CAD) in acute coronary syndrome (ACS) may support timely invasive management. The CHA₂DS₂-VASc-HSF score is available at the bedside, but evidence in South Asian populations is limited. Objective: To evaluate the predictive value of the admission CHA₂DS₂-VASc-HSF score for CAD severity and its correlation with angiographic complexity in patients with ACS. Methods: This retrospective observational study included 96 adults with STEMI, NSTEMI, or unstable angina who underwent invasive coronary angiography at a tertiary cardiac centre in Chennai, India, between January and June 2026. Admission scores, clinical and laboratory variables, SYNTAX scores, number of diseased vessels, procedural complications, and 30-day outcomes were analysed. Receiver operating characteristic analysis was used to assess discrimination for severe or complex CAD. Results: Higher scores correlated positively with SYNTAX score (r = .64, p < .001) and number of diseased vessels (r = .58, p < .001), and inversely with left ventricular ejection fraction (r = −.42, p < .001). A score threshold of ≥3 discriminated a high SYNTAX score with an AUC of 0.812, 82.1% sensitivity, and 70.6% specificity. Higher score categories were also associated with multivessel disease, left main involvement, periprocedural no-reflow, acute kidney injury, longer intensive care stays, and 30-day composite adverse outcomes. Conclusion: The admission score showed clinically relevant associations with angiographic complexity and early outcomes and may be useful as an adjunct to established ACS risk assessment.