Prestroke CHA2DS2-VASc Score and Severity of Acute Stroke in Patients with Atrial Fibrillation: Findings from RAF Study

• DOI: 10.1016/j.jstrokecerebrovasdis.2017.02.011
• Publication Date: 2017-02-22T21:01:23Z
• Authors: Monica Acciarresi; Maurizio Paciaroni; Giancarlo Agnelli; Nicola Falocci; Valeria Caso; Cecilia Becattini; Simona Marcheselli; Christina Rueckert; Alessandro Pezzini; Andrea Morotti; Paolo Costa; Alessandro Padovani; Laszló Csiba; Lilla Szabó; Sung-Il Sohn; Tiziana Tassinari; Azmil H. Abdul-Rahim; Patrik Michel; Maria Cordier; Peter Vanacker; Suzette Remillard; Andrea Alberti; Michele Venti; Cataldo D'Amore; Umberto Scoditti; Licia Denti; Giovanni Orlandi; Alberto Chiti; Gino Gialdini; Paolo Bovi; Monica Carletti; Alberto Rigatelli; Jukka Putaala; Turgut Tatlisumak; Luca Masotti; Gianni Lorenzini; Rossana Tassi; Francesca Guideri; Giuseppe Martini; Georgios Tsivgoulis; Kostantinos Vadik...; Chrissoula Lianti...; Francesco Corea; Massimo Del Sette; Walter Ageno; Maria Luisa De Lo...; Giorgio Bono; Antonio Baldi; Sebastiano D'Anna; Simona Sacco; Antonio Carolei; Cindy Tiseo; Davide Imberti; Dorjan Zabzuni; Boris Doronin; Vera Volodina; Domenico Consoli; Franco Galati; Alessio Pieroni; Danilo Toni; Serena Monaco; Mario Maimone Bar...; Kristian Barlinn; Lars-Peder Pallesen; Jessica Kepplinger; Ulf Bodechtel; Johannes Gerber; Dirk Deleu; Gayane Melikyan; Faisal Ibrahim; Naveed Akhtar; Maria Giulia Mosconi; Kennedy R. Lees
• Keywords: Male; atrial fibrillation; CHA; 2; DS; 2; -VASc score; Ischemic stroke; outcome; scores; severity; Aged; Aged, 80 and over; Area Under Curve; Asia; Atrial Fibrillation; Chi-Square Distribution; Disability Evaluation; Europe; Female; Humans; Linear Models; Logistic Models; Magnetic Resonance Imaging; Male; Multivariate Analysis; Odds Ratio; Predictive Value of Tests; Prognosis; Prospective Studies; ROC Curve; Risk Assessment; Risk Factors; Severity of Illness Index; Stroke; Time Factors; Tomography, X-Ray Computed; Decision Support Techniques; Time Factors; atrial fibrillation; CHA2DS2-VASc score; Ischemic stroke; outcome; scores; severity; Aged; Aged, 80 and over; Area Under Curve; Asia; Atrial Fibrillation; Chi-Square Distribution; Disability Evaluation; Europe; Female; Humans; Linear Models; Logistic Models; Magnetic Resonance Imaging; Male; Multivariate Analysis; Odds Ratio; Predictive Value of Tests; Prognosis; Prospective Studies; ROC Curve; Risk Assessment; Risk Factors; Severity of Illness Index; Stroke; Time Factors; Tomography, X-Ray Computed; Decision Support Techniques; Surgery; Rehabilitation; Neurology (clinical); Cardiology and Cardiovascular Medicine; ARTERIAL TERRITORIES; severity; Predictive Value of Test; Severity of Illness Index; CHADS(2); Decision Support Technique; Atrial fibrillation; CHA2DS2-VASc score; Ischemic stroke; Outcome; Scores; Severity; Surgery; Rehabilitation; Neurology (clinical); Cardiology and Cardiovascular Medicine; scores; Disability Evaluation; 0302 clinical medicine; Risk Factors; Atrial Fibrillation; 80 and over; Odds Ratio; score; atrial fibrillation; Elméleti orvostudományok; ACUTE ISCHEMIC-STROKE; Prospective Studies; DS; Multivariate Analysi; Tomography; Aged, 80 and over; OUTCOMES; Ischemic stroke; Rehabilitation; Orvostudományok; HUMAN BRAIN; Prognosis; Magnetic Resonance Imaging; General medicine, internal medicine and other clinical medicine; X-Ray Computed; Stroke; Europe; Area Under Curve; CHA(2)DS(2)-VASc score; outcome; Linear Model; Female; Cardiology and Cardiovascular Medicine; Human; Asia; Logistic Model; Time Factor; Prognosi; CHA2DS2-VASc score; 2; 610; Risk Assessment; -VASc score; Neurology and psychiatry; Decision Support Techniques; 03 medical and health sciences; Predictive Value of Tests; 616; Humans; atrial fibrillation; CHA2DS2-VASc score; ischemic stroke; outcome; scores; severity; surgery; rehabilitation; neurology (clinical); cardiology and cardiovascular medicine; Aged; Chi-Square Distribution; Risk Factor; Neurosciences; Prospective Studie; Logistic Models; ROC Curve; Multivariate Analysis; CHA; Linear Models; Surgery; Neurology (clinical); Human medicine

The aim of this study was to investigate for a possible association between both prestroke CHA2DS2-VASc score and the severity of stroke at presentation, as well as disability and mortality at 90 days, in patients with acute stroke and atrial fibrillation (AF).This prospective study enrolled consecutive patients with acute ischemic stroke, AF, and assessment of prestroke CHA2DS2-VASc score. Severity of stroke was assessed on admission using the National Institutes of Health Stroke Scale (NIHSS) score (severe stroke: NIHSS ≥10). Disability and mortality at 90 days were assessed by the modified Rankin Scale (mRS <3 or ≥3). Multiple logistic regression was used to correlate prestroke CHA2DS2-VASc and severity of stroke, as well as disability and mortality at 90 days.Of the 1020 patients included in the analysis, 606 patients had an admission NIHSS score lower and 414 patients higher than 10. At 90 days, 510 patients had mRS ≥3. A linear correlation was found between the prestroke CHA2DS2-VASc score and severity of stroke (P = .001). On multivariate analysis, CHA2DS2-VASc score correlated with severity of stroke (P = .041) and adverse functional outcome (mRS ≥3) (P = .001). A logistic regression with the receiver operating characteristic graph procedure (C-statistics) evidenced an area under the curve of .60 (P = .0001) for severe stroke. Furthermore, a correlation was found between prestroke CHA2DS2-VASc score and lesion size.In patients with AF, in addition to the risk of stroke, a high CHA2DS2-VASc score was independently associated with both stroke severity at onset and disability and mortality at 90 days.