BackgroundChronic kidney disease (CKD) patients have a high prevalence of coronary artery disease and a high risk of cardiovascular events. The present study assessed the value of the CHA(2)DS(2)-VASc score for predicting mortality among hospitalized acute coronary syndrome (ACS) patients with CKD. MethodsThis was a retrospective cohort study that included CKD patients who were hospitalized for ACS from January 2015 to May 2020. The CHA(2)DS(2)-VASc score for each eligible patient was determined. Patients were stratified into two groups according to CHA(2)DS(2)-VASc score: <6 (low) and >= 6 (high). The primary endpoint was all-cause mortality. ResultsA total of 313 eligible patients were included in the study, with a mean CHA(2)DS(2)-VASC score of 4.55 +/- 1.68. A total of 220 and 93 patients were assigned to the low and high CHA(2)DS(2)-VASc score groups, respectively. The most common reason for hospitalization was unstable angina (39.3%), followed by non-ST-elevation myocardial infarction (35.8%) and ST-elevation myocardial infarction (24.9%). A total of 67.7% of the patients (212/313) received coronary reperfusion therapy during hospitalization. The median follow-up time was 23.0 months (interquartile range: 12-38 months). A total of 94 patients (30.0%) died during follow-up. The high score group had a higher mortality rate than the low score group (46.2 vs. 23.2%, respectively; p < 0.001). The cumulative incidence of all-cause death was higher in the high score group than in the low score group (Log-rank test, p < 0.001). Multivariate Cox regression analysis indicated that CHA(2)DS(2)-VASc scores were positively associated with all-cause mortality (hazard ratio: 2.02, 95% confidence interval: 1.26-3.27, p < 0.001). ConclusionThe CHA(2)DS(2)-VASc score is an independent predictive factor for all-cause mortality in CKD patients who are hospitalized with ACS. This simple and practical scoring system may be useful for the early identification of patients with a high risk of death.