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.
Cohort (n=1,756)
Hazard Ratio: 3.66 (95% CI 2.38–5.62)
p-value: p=<0.0001
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.
Ntaios et al. (Thu,) 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.