Key result
High prestroke CHADS2 scores were associated with significantly higher 5-year mortality compared to low scores (HR 3.66; 95% CI 2.38-5.62) in non-AF patients with acute ischemic stroke.
Why the study?
Do prestroke CHADS2 and CHA2DS2-VASc scores predict long-term stroke outcomes in patients with acute first-ever ischemic stroke without atrial fibrillation?
Cohort (n=1,756)
Do prestroke CHADS2 and CHA2DS2-VASc scores predict long-term stroke outcomes in patients with acute first-ever ischemic stroke without atrial fibrillation?
Prestroke CHADS2 and CHA2DS2-VASc scores can effectively stratify long-term prognostic risk for mortality, stroke recurrence, and cardiovascular events in non-AF patients with acute ischemic stroke.
Answers are grounded in this paper and cite their sources.
Supports prestroke CHADS2 for mortality risk stratification in non-AF stroke; leaves open therapeutic implications pending validation.
OBJECTIVE: CHADS2 and CHA2DS2-VASc scores are used to assess stroke risk in patients with atrial fibrillation (AF). We investigated whether these scores are associated with stroke outcome in non-AF stroke patients. METHODS: Consecutive patients with acute first-ever ischemic stroke but without AF were classified into subgroups according to prestroke CHADS2 and CHA2DS2-VASc scores and followed up for 5 years. The end points were death, stroke recurrence, and a composite of major cardiovascular events. RESULTS: Among 1,756 patients (aged 67.2 ± 12.3 years, 68.2% males), there were 258 (14.7%), 617 (35.3%), and 878 (50.0%) patients with low, intermediate, and high CHADS2 score, respectively. The corresponding figures for CHA2DS2-VASc subgroups were 110 (6.3%), 255 (14.5%), and 1,391 (79.2%). There were significant differences between CHADS2 subgroups in 5-year mortality (log-rank test = 74.5, p < 0.0001), stroke recurrence (log-rank test = 12.3, p = 0.002), and cardiovascular events (log-rank test = 19.4, p < 0.001). Similarly, there were significant differences between CHA2DS2-VASc subgroups in 5-year mortality (log-rank test = 74.5, p < 0.0001), stroke recurrence (log-rank test = 10.6, p = 0.005), and cardiovascular events (log-rank test = 16.4, p < 0.001). Compared with the low-risk group, patients in intermediate- and high-risk CHADS2 subgroups had higher 5-year mortality (hazard ratio [HR]: 2.22 [95% confidence interval {CI}: 1.78-2.77] and 3.66 [95% CI: 2.38-5.62], respectively), stroke recurrence (HR: 1.74 [95% CI: 1.09-2.79] and 1.71 [95% CI: 1.08-2.71], respectively), and cardiovascular events (HR: 1.78 [95% CI: 1.23-2.57] and 1.86 [95% CI: 1.30-2.67], respectively). Compared with the low-risk group, patients in the high-risk CHA2DS2-VASc subgroup also had higher 5-year mortality (HR: 3.56, 95% CI: 1.89-6.70), stroke recurrence (HR: 2.93, 95% CI: 1.30-6.61), and cardiovascular events (HR: 2.71, 95% CI: 1.49-4.95). CONCLUSIONS: Prestroke CHADS2 and CHA2DS2-VASc scores predict long-term stroke outcomes in non-AF patients with acute ischemic stroke. These scores may provide a simple way of stroke prognostic risk stratification among non-AF stroke patients.
No takes yet. Share an insight, caveat, or question.
Ntaios et al. (2013) conducted a cohort in Acute first-ever ischemic stroke without atrial fibrillation (n=1,756). High CHADS2 score vs. Low CHADS2 score was evaluated on 5-year mortality (HR 3.66, 95% CI 2.38-5.62, p=<0.0001). High prestroke CHADS2 scores were associated with significantly higher 5-year mortality compared to low scores (HR 3.66; 95% CI 2.38-5.62) in non-AF patients with acute ischemic stroke.
Synapse has enriched 10 related papers. Consider them for comparative context: