JOMPAC
Journal of Medicine and Palliative Care

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Original Article
The prognostic role of the CHA²DS²-VASc score in patients with acute myocardial infarction receiving extracorporeal membrane oxygenation following out-of-hospital cardiac arrest
Abstract
Aims: The CHA²DS²-VASc scoring system has been widely used for stroke risk stratification in patients with atrial fibrillation, yet evidence regarding its prognostic value in other critical settings remains limited. This study aimed to assess the utility of the CHA²DS²-VASc score in predicting mortality in patients with acute myocardial infarction (AMI) who received veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support following out-of-hospital cardiac arrest.
Methods: This retrospective study included 41 patients with AMI requiring VA-ECMO after OHCA. Baseline demographics, clinical characteristics, and prognostic scores, including CHA²DS²-VASc, SAVE (Survival After Veno-Arterial ECMO), Glasgow Coma Scale (GCS), and acute physiology and chronic health evaluation (APACHE) II were recorded. Patients were categorized into three risk groups based on the CHA²DS²-VASc score: low (0 points), moderate (1 point), and high (?2 points). According to the SAVE score, patients were classified into five risk groups: class I (?5 points), class II (1–4 points), class III (-4 to 0 points), class IV (-9 to -5 points), and class V (?-10 points). The primary outcome was in-hospital mortality.
Results: The overall in-hospital mortality rate was 58.5%. Patients with high risk group had a significantly higher mortality risk (HR: 3.12, 95% CI: 1.28-7.63, p=0.008). The SAVE score had the highest diagnostic performance, with a sensitivity of 81.2% and specificity of 76.5% (AUC=0.80). CHA²DS²-VASc (AUC=0.74) and APACHE II (AUC=0.72) also demonstrated good predictive performance. While CHA²DS²-VASc maintained a balanced sensitivity (70.8%) and specificity (64.7%), APACHE II had higher sensitivity (75.7%) but lower specificity (58.8%). GCS demonstrated the lowest diagnostic performance (AUC=0.68).
Conclusion: While the SAVE score, a risk model specifically designed for VA-ECMO, provides a strong prognostic evaluation, the CHA²DS²-VASc score could be a simple and easily applicable tool for early risk stratification in this high-risk population.

Keywords : CHA2DS2-VASc score, extracorporeal membrane oxygenation, cardiogenic shock, mortality

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1. Abbas R, Abbas A, Khan TK, Sharjeel S, Amanullah K, Irshad Y. Sudden cardiac death in young individuals: a current review of evaluation, screening and prevention. J Clin Med Res. 2023;15(1):1-9. doi:10.14740/jocmr4823
2. Lott C, Truhlar A, Alfonzo A, et al. European resuscitation council guidelines 2021: Cardiac arrest in special circumstances. Resuscitation. 2021;161:152-219. doi:10.1016/j.resuscitation.2021.02.011
3. Tsangaris A, Alexy T, Kalra R, et al. Overview of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support for the management of cardiogenic shock. Front Cardiovasc Med. 2021;8: 686558. doi:10.3389/fcvm.2021.686558
4. Rao P, Khalpey Z, Smith R, Burkhoff D, Kociol RD. Venoarterial extracorporeal membrane oxygenation for cardiogenic shock and cardiac arrest. Circ Heart Fail. 2018;11(9):e004905. doi:10.1161/CIRCHEARTFAILURE.118.004905
5. De Charriere A, Assouline B, Scheen M, et al. ECMO in cardiac arrest: a narrative review of the literature. J Clin Med. 2021;10(3):534. doi:10. 3390/jcm10030534
6. Aufderheide TP, Kalra R, Kosmopoulos M, Bartos JA, Yannopoulos D. Enhancing cardiac arrest survival with extracorporeal cardiopulmonary resuscitation: insights into the process of death. Ann N Y Acad Sci. 2022; 1507(1):37-48. doi:10.1111/nyas.14580
7. Gill G, Patel JK, Casali D, et al. Outcomes of venoarterial extracorporeal membrane oxygenation for cardiac arrest in adult patients in the United States. J Am Heart Assoc. 2021;10(20):e021406. doi:10.1161/JAHA.121. 021406
8. Schmidt M, Burrell A, Roberts L, et al. Predicting survival after ECMO for refractory cardiogenic shock: the survival after veno-arterial-ECMO (SAVE)-score. Eur Heart J. 2015;36(33):2246-2256. doi:10.1093/eurheartj/ehv194
9. Sudarsanan S, Sivadasan P, Chandra P, et al. Comparison of four intensive care scores in predicting outcomes after venoarterial extracorporeal membrane oxygenation: a single-center retrospective study. J Cardiothorac Vasc Anesth. 2025;39(1):131-142. doi:10.1053/j.jvca. 2024.10.027
10. Fisser C, Rincon-Gutierrez LA, Enger TB, et al. Validation of prognostic scores in extracorporeal life support: a multi-centric retrospective study. Membranes (Basel). 2021;11(2):84. doi:10.3390/membranes11020084
11. Muller G, Flecher E, Lebreton G, et al. The ENCOURAGE mortality risk score and analysis of long-term outcomes after VA-ECMO for acute myocardial infarction with cardiogenic shock. Intensive Care Med. 2016;42(3):370-378. doi:10.1007/s00134-016-4223-9
12. Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest. 2010;137(2):263-272. doi:10.1378/chest.09-1584
13. Abouzid MR, Kamel I, Saleh A, Vidal Margenat A, Hariharan R. Assessing stroke and mortality risk in heart failure: the CHA2DS2-VASc score's prognostic value in patients with and without atrial fibrillation: a meta-analysis. Cardiol Rev. Published online August 15, 2024. doi:10.1097/CRD.0000000000000749
14. Allam H, Mostafa S, Abd Khalek ES, Abdalla S. Predictive role of CHA(2)DS(2)-VASc score in acute coronary syndrome patients and value of adding global longitudinal strain to CHA(2)DS(2)-VASc score. Indian Heart J. Published online December 21, 2024.; doi:10.1016/j.ihj. 2024.12.001
15. Cicek V, Cinar T, Hayiroglu MI, et al. Prognostic performance of CHA(2)DS(2)-VASc scores for predicting mortality among COVID-19 patients: a single pandemic center experience. Am J Emerg Med. 2021;45:635-637. doi:10.1016/j.ajem.2020.11.026
16. Eckman PM, Katz JN, El Banayosy A, Bohula EA, Sun B, van Diepen S. Veno-arterial extracorporeal membrane oxygenation for cardiogenic shock: an introduction for the busy clinician. Circulation. 2019;140(24): 2019-2037. doi:10.1161/CIRCULATIONAHA.119.034512
17. Harnisch LO, Moerer O. Contraindications to the initiation of veno-venous ECMO for severe acute respiratory failure in adults: a systematic review and practical approach based on the current literature. Membranes (Basel). 2021;11(8):584. doi:10.3390/membranes11080584
18. Kurmani S, Squire I. Acute heart failure: definition, classification and epidemiology. Curr Heart Fail Rep. 2017;14(5):385-392. doi:10.1007/s11897-017-0351-y
19. Hacke W, Bassand JP, Virdone S, et al. Prior stroke and transient ischemic attack as risk factors for subsequent stroke in atrial fibrillation patients: a report from the GARFIELD-AF registry. Int J Stroke. 2020; 15(3):308-317. doi:10.1177/1747493019891516
20. Amin F, Lombardi J, Alhussein M, et al. Predicting survival after VA-ECMO for refractory cardiogenic shock: validating the SAVE score. CJC Open. 2021;3(1):71-81. doi:10.1016/j.cjco.2020.09.011
21. Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37(38):2893-2962. doi:10.1093/eurheartj/ehw 210
22. DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44(3):837-45.
23. Morimoto R, Kida H, Tachibana K, Watanabe T, Yamada T. Prognostic factors in patients with acute myocardial infarction underwent extracorporeal membrane oxygenation in hospital or out-of-hospital cardiac arrest. Eur Heart J. 2021;42(Supplement_1):ehab724.1480. doi: 10.1093/eurheartj/ehab724.1480
24. Lee JJ, Han SJ, Kim HS, et al. Out-of-hospital cardiac arrest patients treated with cardiopulmonary resuscitation using extracorporeal membrane oxygenation: focus on survival rate and neurologic outcome. Scand J Trauma Resusc Emerg Med. 2016;24(1):74. doi:10.1186/s13049-016-0266-8
25. Misumi K, Hagiwara Y, Kimura T, et al. Impact of center volume on in-hospital mortality in adult patients with out-of-hospital cardiac arrest resuscitated using extracorporeal cardiopulmonary resuscitation: a secondary analysis of the SAVE-J II study. Scientific Reports. 2024;14(1): 8309. doi:10.1038/s41598-024-58808-y
26. Ravipati P, Murray S, Yannopoulos D, Drawz PE, Bartos JA. Impact of AKI in patients with out-of-hospital cardiac arrest managed with VA ECMO. Kidney360. 2021;2(11):1827-1830. doi:10.34067/KID.0006592020
27. Schmidt M, Zogheib E, Roze H, et al. The PRESERVE mortality risk score and analysis of long-term outcomes after extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. Intensive Care Med. 2013;39(10):1704-1713. doi:10.1007/s00134-013-3037-2
28. Ng WT, Ling L, Joynt GM, Chan KM. An audit of mortality by using ECMO specific scores and APACHE II scoring system in patients receiving extracorporeal membrane oxygenation in a tertiary intensive care unit in Hong Kong. J Thorac Dis. 2019;11(2):445-455. doi:10.21037/jtd.2018.12.121
29. Hayakawa K, Tasaki O, Hamasaki T, et al. Prognostic indicators and outcome prediction model for patients with return of spontaneous circulation from cardiopulmonary arrest: the Utstein Osaka Project. Resuscitation. 2011;82(7):874-880. doi:10.1016/j.resuscitation.2011.02. 045
30. Grandbois van Ravenhorst C, Schluep M, Endeman H, Stolker RJ, Hoeks SE. Prognostic models for outcome prediction following in-hospital cardiac arrest using pre-arrest factors: a systematic review, meta-analysis and critical appraisal. Crit Care. 2023;27(1):32. doi:10.1186/s13054-023-04306-y
31. Tran A, Rochwerg B, Fan E, et al. Prognostic factors associated with favourable functional outcome among adult patients requiring extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest: a systematic review and meta-analysis. Resuscitation. 2023;193:110004. doi:10.1016/j.resuscitation.2023.110004
32. Tran A, Fernando SM, Rochwerg B, et al. Pre-arrest and intra-arrest prognostic factors associated with survival following traumatic out-of-hospital cardiac arrest -a systematic review and meta-analysis. Resuscitation. 2020;153:119-135. doi:10.1016/j.resuscitation.2020.05.052
33. George N, Stephens K, Ball E, et al. Extracorporeal membrane oxygenation for cardiac arrest: does age matter? Crit Care Med. 2024; 52(1):20-30. doi:10.1097/CCM.0000000000006039
34. Bemtgen X, Rilinger J, Jackel M, et al. Admission blood glucose level and outcome in patients requiring venoarterial extracorporeal membrane oxygenation. Clin Res Cardiol. 2021;110(9):1484-1492. doi:10.1007/s00392-021-01862-7
35. Mariani S, Heuts S, van Bussel BCT, et al. Patient and management variables associated with survival after postcardiotomy extracorporeal membrane oxygenation in adults: the PELS-1 multicenter cohort study. J Am Heart Assoc. 2023;12(14):e029609. doi:10.1161/JAHA.123.029609
36. Kang J, Lee H, Han S, Cho H. Predictors of mortality in patients with VA-extracorporeal membrane oxygenation. Eur Heart J. 2020; 41(Supplement_2):ehaa946.1237. doi:10.1093/ehjci/ehaa946.1237
37. Gazova A, Leddy JJ, Rexova M, Hlivak P, Hatala R, Kyselovic J. Predictive value of CHA2DS2-VASc scores regarding the risk of stroke and all-cause mortality in patients with atrial fibrillation (CONSORT compliant). Medicine (Baltimore). 2019;98(31):e16560. doi:10.1097/MD. 0000000000016560
38. Inan D, Genc D, Simsek B, et al. Relationship between CHA(2)DS(2)-VASc score on admission and in-hospital major adverse cardiovascular events in patients diagnosed with ST-elevation myocardial infarction. Angiology. 2024:33197241273382. doi:10.1177/00033197241273382
39. Wang CH, Chen YY, Wu MC, et al. Pre-arrest atrial fibrillation and neurological recovery after cardiac arrest among hospitalized patients: a retrospective cohort study. Eur J Clin Invest. 2025;55(3):e14375. doi:10. 1111/eci.14375
40. Mo R, Yang YM, Zhang H, Suo N, Wang JY, Lyu SQ. Clinical application of CHA(2)DS(2)-VASc versus GRACE scores for assessing the risk of long-term ischemic events in atrial fibrillation and acute coronary syndrome or PCI. Rev Cardiovasc Med. 2022;23(5):168. doi:10.31083/j.rcm2305168
41. Chua SK, Lo HM, Chiu CZ, Shyu KG. Use of CHADS(2) and CHA(2)DS(2)-VASc scores to predict subsequent myocardial infarction, stroke, and death in patients with acute coronary syndrome: data from Taiwan acute coronary syndrome full spectrum registry. PLoS One. 2014;9(10): e111167. doi:10.1371/journal.pone.0111167
42. Boriani G, Vitolo M, Mei DA. CHA2DS2-VA instead of CHA2DS2-VASc for stroke risk stratification in patients with atrial fibrillation: not just a matter of sex. Europace. 2024;26(11):euae281. doi:10.1093/europace/euae281
43. Ibdah R, Obeidat O, Khader Y, et al. Validation of CHA2DS2 VASc score predictability of stroke and systemic embolization in a Middle Eastern population with AF: the Jordan atrial fibrillation (JoFib) study. Vasc Health Risk Manag. 2023;19:255-264. doi:10.2147/VHRM.S404575
Article available in :
Volume 6, Issue 2, 2025
Page : 116-123
https://doi.org/10.47582/jompac.1642835
Article Information
Received : 19 Şub 2025
Accepted : 16 Mar 2025
Published : 23 Mar 2025
Corresponding Author :

Onur Yıldırım: Department of Cardiology, Faculty of Medicine, Lokman Hekim University, Ankara, Turkiye

[email protected]
Citation : Yıldırım O, Çolak N, Nazlı Y, Yöndem ÖZ, Okutucu S. The prognostic role of the CHA²DS²-VASc score in patients with acute myocardial infarction receiving extracorporeal membrane oxygenation following out-of-hospital cardiac arrest. J Med Palliat Care. 2025;6(2):116-123.

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