Prestroke CHA2DS2-VASc Score and Severity of Acute Stroke in Patients with Atrial Fibrillation: Findings from RAF Study
- Affiliated Author(s)
- 손성일
- Alternative Author(s)
- Sohn, Sung Il
- Journal Title
- Journal of Stroke and Cerebrovascular Diseases
- ISSN
- 1052-3057
- Issued Date
- 2017
- Keyword
- Ischemic stroke; CHA2DS2-VASc score; severity; outcome; atrial fibrillation; scores
- Abstract
- Background and Purpose: 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). Methods: 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. Results:
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. Conclusions: 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.
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