Key result
A high CHA2DS2-VASc score (≥2) independently predicted a significantly higher risk of 1-year major adverse cardiac and cerebrovascular events compared to a low score (<2) in patients with acute ischemic stroke (adjusted HR 1.63).
Why the study?
Does a high CHA2DS2-VASc score or the presence of atrial fibrillation predict 1-year MACCEs in patients hospitalized with acute ischemic stroke?
Cohort (n=62,227)
Yes
Does a high CHA2DS2-VASc score or the presence of atrial fibrillation predict 1-year MACCEs in patients hospitalized with acute ischemic stroke?
Hazard Ratio: 1.63 (95% CI 1.52–1.76)
Absolute Event Rate: 12.7% vs 7.2%
p-value: p=<0.001
The CHA2DS2-VASc score and atrial fibrillation are independent predictors of 1-year MACCEs in patients with acute ischemic stroke, supporting the score's utility for risk stratification beyond just AF populations.
Supports CHA2DS2-VASc for MACCE risk stratification in acute ischemic stroke beyond AF; leaves open need for prospective trials to guide interventions.
PURPOSE: Atrial fibrillation (AF) is a significant independent risk factor for 1-year mortality in patients with first acute ischemic stroke (AIS). The CHA2DS2-VASc score was initially developed to assess the risk of stroke in patients with AF. Recently, this scoring system has been demonstrated to have clinical value for predicting long-term clinical outcomes in AIS but the evidence is insufficient. This large-scale prospective cohort study investigated the independent predictive value of the score in such patients. METHODS: We included patients with AIS from the Taiwan Stroke Registry (TSR) during 2006-2016 as the present study population. Patients were divided into those with high (≥2) and low (<2) CHA2DS2-VASc scores. We further analyzed and classified patients according to the presence of AF. The clinical endpoint was major adverse cardiac and cerebrovascular events (MACCEs) at 1 year after the index AIS. RESULTS: A total of 62,227 patients with AIS were enrolled. The median age was 70.3 years, and 59% of the patients were women. After confounding factors were controlled, patients with high CHA2DS2-VASc scores had significantly higher incidence of 1-year MACCEs (adjusted hazard ratio [HR] = 1.63; 95% confidence interval [CI] = 1.52, 1.76), re-stroke (adjusted HR = 1.28; 95% CI = 1.16, 1.42), and all-cause mortality (adjusted HR = 2.03; 95% CI = 1.83, 2.24) than those with low CHA2DS2-VASc scores did. In the comparison between AF and non-AF groups, the AF group had increased MACCEs (adjusted HR = 1.74; 95% CI = 1.60, 1.89), myocardial infarction (adjusted HR = 4.86; 95% CI = 2.07, 11.4), re-stroke (adjusted HR = 1.47; 95% CI = 1.26, 1.71), and all-cause mortality (adjusted HR = 1.90; 95% CI = 1.72, 2.10). The Kaplan-Meier curve revealed that both CHA2DS2-VASc scores and AF were independent risk predictors for 1-year MACCEs and mortality. CONCLUSIONS: The CHA2DS2-VASc score and AF appeared to consistently predict 1-year MACCEs of AIS patients and provide more accurate risk stratification. Therefore, increased use of the CHA2DS2-VASc score may help improve the holistic clinical assessment of AIS patients with or without AF.
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Su et al. (2022) conducted a cohort in Acute ischemic stroke (n=62,227). High CHA2DS2-VASc score (≥2) vs. Low CHA2DS2-VASc score (<2) was evaluated on Major adverse cardiac and cerebrovascular events (MACCEs) at 1 year (HR 1.63, 95% CI 1.52-1.76, p=<0.001). A high CHA2DS2-VASc score (≥2) independently predicted a significantly higher risk of 1-year major adverse cardiac and cerebrovascular events compared to a low score (<2) in patients with acute ischemic stroke (adjusted HR 1.63).
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