Background: Early risk stratification of patients with atrial
fibrillation (AF) and acute coronary syndrome (ACS) or undergoing percutaneous
coronary intervention (PCI) has relevant implication for individualized
management strategies. The CHADS-VASc and GRACE ACS risk model are
well-established risk stratification systems. We aimed to assess their prognostic
performance in AF patients with ACS or PCI. Methods: Consecutive
patients with AF and ACS or referred for PCI were prospectively recruited and
followed up for 3 years. The primary endpoint was major adverse cardiovascular
and cerebrovascular events (MACCEs), including cardiovascular mortality,
myocardial infarction, ischemic stroke, systemic embolism and ischemia-driven
revascularization. Results: Higher CHADS-VASc (HR [hazard
ratio] 1.184, 95% CI 1.091–1.284) and GRACE at discharge score (HR 1.009, 95%
CI 1.004–1.014) were independently associated with increased risk of MACCEs. The
CHADS-VASc (c-statistics: 0.677) and GRACE at discharge
(c-statistics: 0.699) demonstrated comparable discriminative capacity for MACCEs
(p = 0.281) while GRACE at admission provided relatively lower
discrimination (c-statistics: 0.629, p vs. CHADS-VASc =
0.041). For predicting all-cause mortality, three models displayed good
discriminative capacity (c-statistics: 0.750 for CHADS-VASc, 0.775
for GRACE at admission, 0.846 for GRACE at discharge). A significant
discrimination improvement of GRACE at discharge compared to
CHADS-VASc was detected (NRI = 45.13%). Conclusions: In the
setting of coexistence of AF and ACS or PCI, CHADS-VASc and GRACE at
discharge score were independently associated with an increased risk of MACCEs.
The GRACE at discharge performed better in predicting all-cause mortality.