Themajor finding of the present study is that CHA2DS2-VAScscore is independently associated with severity of atherosclerosis in patientswith CAD. In this study burden of atherosclerosis was assessed by SYNTAX scoreand CIMT.Componentsof CHA2DS2-VAScscore are known to promote atherosclerosis and are associated with severity ofCAD.
88 First, low ejectionfraction can be explained that, it is not the cause of complex lesions, but itis the outcome of CAD severity. As the complexity and number of lesions, suchas chronic total occlusion, bifurcation and ostial lesions increase, it leadsto increase in SYNTAX score. Therefore, angiographic lesion characteristics andcomplexity may impact ventricular systolic functions, so low ejection fractionindirectly indicate angiographic severity of CAD . Also, patientswith heart failure usually have neurohumoral and inflammatory response and someof these are associated with atherosclerosis pathogenesis. High levels ofinflammatory markers, especially high sensitive C-reactive protein, have beenassociated with left ventricular systolic dysfunction.89Theother components of this score like hypertension, DM and age are traditionalrisk factors for CAD. Moreover, diabetic patients are known to have increasedseverity of atherosclerosis as well as higher rates of multivessel disease andmore complex lesions such as long lesions, bifurcation lesions and diffusesmall vessel disease.
88 Anothercomponent CVA can be explained as suggested by, in Yoo J90 et al. investigatorssuggested that a substantial portion of stroke patients have preclinical CADand there is a clear association between coronary and cerebral arteryatherosclerosis in terms of location and burden.90 The risk of CADis particularly high in stroke patients with multiple risk factors andatherosclerosis of the carotid and/or vertebrobasilar arteries.88 Inanother study, Korkmaz91 et al. found increased coronary arterylesion complexity among patients with acute coronary syndrome and peripheralartery disease. There was a strong correlation between degree of peripheralartery disease and atherosclerosis severity in coronary arteries. Pearsoncorrelation showed positive correlation between CHA2DS2-VAScscore and SYNTAX score.
Anotherestablished surrogate marker of atherosclerosis is CIMT. In Ikeda N23et al. study a statistically significant correlation was found between the CIMTand SYNTAX score and also between the plaque score and SYNTAX score.
Pearsoncorrelation, showed positive correlation between CHA2DS2-VAScscore and CIMT.CHA2DS2-VAScscore is a simple and easily remembered scoring system. This score is useful incardiovascular risk stratification, and its best part would be, it can be doneclinically without additional cost.
This clinical score also might enablephysicians to select patients for primary prevention of atherosclerosis and toidentify patients who will benefit from further diagnostic tests for CAD.Limitations of thestudy are, We had no follow-up data such as in hospital or 30-day mortality andcomplications that could provide more information on prognostic value of CHA2DS2-VAScscore and it should validated in larger study population.In conclusion, CHA2DS2-VAScscore may emerge as an excellent bedside simple clinical scoring system to predictatherosclerosis burden and guide to implement preventive therapy forcardiovascular disease. This study shows that by calculating CHA2DS2-VAScscore and measuring CIMT with B-mode ultrasound, one can predict CAD burdennon-invasively and can investigate accordingly.