CHA2DS2-VASc score in acute ischemic stroke with atrial fibrillation: results from the Clinical Research Collaboration for Stroke in Korea

Lee, Hak Loh; Kim, Joon Tae; Lee, Ji Sung; Kim, Beom Joon; Park, Jong‐Moo; Kang, Kyusik; Lee, Soo Joo; Kim, Jae Guk; Kwan, Jae; Kim, Dae Hyun; Park, Tai Hwan; Park, Sang Soon; Lee, Kyung Bok; Lee, Jun; Hong, Keun Sik; Cho, Yong Jin; Park, Hong‐Kyun; Lee, Byung Chul; Yu, Kyung Ho; Oh, Mi Sun; Kim, Dong Eog; Ryu, Wi‐Sun; Choi, Jay Chol; Kwon, Jee Hyun; Kim, Wook Joo; Shin, Dong Ick; Sohn, Sung Il; Hong, Jeong Ho; Park, Man‐Seok; Choi, Kang Ho; Cho, Ki-Hyun; Lee, Jun-Young; Bae, Hee Joon

doi:10.1038/s41598-020-80874-1

Cited by 4 publications

(3 citation statements)

References 17 publications

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“…To avoid model overfitting, variables for adjustment were selected according to the predetermined following criteria: (1) for recurrent ischemic stroke, among established risk factors of stroke recurrence, 3,11,[14][15][16][17] variables with a P<0.15 in bivariate analysis were chosen; (2) for the all-cause mortality, initial National Institutes of Health Stroke Scale score, 3 and initial systolic blood pressure 3 were chosen additionally; (3) discharge antithrombotics were predetermined as covariates for both of recurrent ischemic stroke and all-cause death; (4) CHA 2 DS 2 -VASc score was selected to adjust possible imbalances by risk factors not included in the models. Multicollinearity among covariates was examined by variance inflation factor.…”

Section: Discussionmentioning

confidence: 99%

Covert Brain Infarction as a Risk Factor for Stroke Recurrence in Patients With Atrial Fibrillation

Kim

Han

Jeong

et al. 2023

Stroke

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Background: We aimed to evaluate covert brain infarction (CBI), frequently encountered during the diagnostic work-up of acute ischemic stroke, as a risk factor for stroke recurrence in patients with atrial fibrillation (AF). Methods: For this prospective cohort study, from patients with acute ischemic stroke hospitalized at 14 centers between 2017 and 2019, we enrolled AF patients without history of stroke or transient ischemic attack and divided them into the CBI (+) and CBI (−) groups. The 2 groups were compared regarding the 1-year cumulative incidence of recurrent ischemic stroke and all-cause mortality using the Fine and Gray subdistribution hazard model with nonstroke death as a competing risk and the Cox frailty model, respectively. Each CBI lesion was also categorized into either embolic-appearing (EA) or non-EA pattern CBI. Adjusted hazard ratios and 95% CIs of any CBI, EA pattern CBI only, non-EA pattern CBI only, and both CBIs were estimated. Results: Among 1383 first-ever stroke patients with AF, 578 patients (41.8%) had CBI. Of these 578 with CBI, EA pattern CBI only, non-EA pattern CBI only, and both CBIs were 61.8% (n=357), 21.8% (n=126), and 16.4% (n=95), respectively. The estimated 1-year cumulative incidence of recurrent ischemic stroke was 5.2% and 1.9% in the CBI (+) and CBI (−) groups, respectively ( P =0.001 by Gray test). CBI increased the risk of recurrent ischemic stroke (adjusted hazard ratio [95% CI], 2.91 [1.44–5.88]) but did not the risk of all-cause mortality (1.32 [0.97–1.80]). The EA pattern CBI only and both CBIs elevated the risk of recurrent ischemic stroke (2.76 [1.32–5.77] and 5.39 [2.25–12.91], respectively), while the non-EA pattern only did not (1.44 [0.40–5.16]). Conclusions: Our study suggests that AF patients with CBI might have increased risk of recurrent stroke. CBI could be considered when estimating the stroke risk in patients with AF.

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Section: Discussionmentioning

confidence: 99%

Covert Brain Infarction as a Risk Factor for Stroke Recurrence in Patients With Atrial Fibrillation

Kim

Han

Jeong

et al. 2023

Stroke

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“…As a result of this study, the presence of slow flow/no-reflow in patients with a CHA2DS2-VASc score of 3 was found 1.7 times more often than in patients with a score of < 3 [ 11 ]. However, so far there are no clear and conclusive data regarding the relationship between response to endovascular or thrombolytic therapy in ischemic stroke and CHA2DS2-VASc score [ 14 – 16 ]. In the present study, we therefore investigated whether pre-stroke CHA2DS2-VASc score is associated with success of endovascular therapy in patients with acute ischemic stroke with and without AF undergoing percutaneous thrombectomy.…”

Section: Discussionmentioning

confidence: 99%

Association of CHA2DS2-VASc score with successful recanalization in acute ischemic stroke patients undergoing endovascular thrombectomy

Nasifov¹,

Özmen²,

Deniz³

et al. 2022

pwki

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Introduction:The CHA2DS2-VASc (congestive heart failure, hypertension, age, diabetes mellitus, stroke, vascular disease and sex) score is a simple risk stratification algorithm to estimate stroke/thromboembolic risk in patients with non-valvular atrial fibrillation (AF). Higher pre-stroke CHA2DS2-VASc score is known to be associated with greater stroke severity and poorer outcomes. AF patients generally have higher CHA2DS2-VASc scores than non-AF patients. The Modified Thrombolysis in Cerebral Infarction (mTICI) score is the most widely used grading system to assess the result of recanalizing therapies in acute ischemic stroke (AIS). mTICI 2c and mTICI 3 are conventionally accepted as successful recanalization.Aim: We investigated whether pre-stroke CHA2DS2-VASc score is associated with mTICI recanalization score in AIS patients with and without AF undergoing percutaneous thrombectomy.Material and methods: One hundred fifty-nine patients with the diagnosis of AIS who were admitted within 6 h from symptom onset were included in the study (mean age: 65.7 ±12.9). All subjects underwent endovascular treatment. CHA2DS2-VASc scores of the participants were calculated. Subjects were grouped according to mTICI scores achieved after endovascular treatment. mTICI 2c and mTICI 3 were accepted as successful recanalization.Results: Successful reperfusion was observed in 130 (81.8%) of all patients who underwent endovascular treatment (mTICI flow ≥ 2c) and first-pass reperfusion was observed in 107 (67.3%) patients. When the patients with successful (mTICI flow ≥ 2c) and unsuccessful (mTICI flow ≤ 2b) reperfusion were divided into groups, no significant difference was observed between the patients in terms of comorbidities such as AF, hypertension, hyperlipidemia, coronary artery disease and cerebrovascular accident history. Patients with unsuccessful reperfusion were older than patients with successful reperfusion (71.4 ±11.2 vs. 64.5 ±13.01, p = 0.006), with a higher CHA2DS2-VASc score (4.1 ±1.5 vs. 3.04 ±1.6, p = 0.002). In addition, the duration of the procedure was longer in the unsuccessful reperfusion group (92.4 ±27.2 min vs. 65.0 ±25.1 min, p < 0.001). CHA2DS2-VASc score significantly correlated with successful recanalization (correlation coefficient; 0.243, p = 0.002). Multivariate logistic regression analysis revealed that only CHA2DS2-VASc score (OR = 1.43, 95% CI: 1.09-1.87, p = 0.006) and procedure time (OR = 1.03, 95% CI: 1.01-1.05, p < 0.001) were independent predictors of successful reperfusion. The receiver-operating characteristic (ROC) curve was used to determine the cutoff value for the CHA2DS2-VASc score that best predicts successful reperfusion. The optimal threshold was 3.5, with a sensitivity of 58.6% and specificity of 59.2% (area under the curve (AUC): 0.669, p = 0.005).Conclusions: For the first time in the literature, we investigated and demonstrated that pre-stroke CHA2DS2-VASc score was associated with success of recanalization as assessed with mTICI 2c and mTICI 3 in a cohort of AIS patients reg...

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“…Stroke risk is increased by artery stiffness (5). It's also associated with vascular events after stroke (6). In the studies of Gasecki and Kwarciany et al, it was shown that short and long-term follow-up outcomes in patients with ischemic stroke DOI: 10.37990/medr.1207426 were worse in the group with high PWV (7,8).…”

Section: Introductionmentioning

confidence: 99%

Relationship between Arterial Stiffness and CHA2DS2-VASc Score in AF-related Stroke Patients

et al. 2023

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Objective: Arterial stiffness (AS) is related with both AF and stroke. The purpose of this study is to examine the association between AS and CHA2DS2-VASc score in patients with AF-related stroke. Materials and Methods: Thirty stroke patients with non-valvular paroxysmal AF participated in this study. Calculations of the patients' CHA2DS2-VASc scores were made. The Carotid-femoral pulse wave velocity (CF-PWV) measured with the SphygmoCor system was used as an indicator of arterial stiffness. It was determined whether or not there was a statistical connection between the CHA2DS2-VASc score and arterial stiffness. Results: Depending on their CHA2DS2-VASc values before to their stroke, the patients were divided into groups (group 1: score=0-1, group 2=score≥2.) The two groups' characteristics were comparable, with the exception of age and systolic blood pressure. Patients with high CHA2DS2-VASc scores ( group 2) demonstrated significantly greater CF-PWV values than those with low scores (group 1).In correlation analysis, the CHA2DS2-VASc score and the CF-PWV showed positive correlation. Conclusion: The CHA2DS2-VASc score and CF-PWV were substantially and linearly associated. Calculation of CHA2DS2-VASc and monitoring of arterial stiffness in stroke-prone individuals may be stimulus for taking preventive measures from stroke in these patients.

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CHA2DS2-VASc score in acute ischemic stroke with atrial fibrillation: results from the Clinical Research Collaboration for Stroke in Korea

Cited by 4 publications

References 17 publications

Covert Brain Infarction as a Risk Factor for Stroke Recurrence in Patients With Atrial Fibrillation

Covert Brain Infarction as a Risk Factor for Stroke Recurrence in Patients With Atrial Fibrillation

Association of CHA2DS2-VASc score with successful recanalization in acute ischemic stroke patients undergoing endovascular thrombectomy

Relationship between Arterial Stiffness and CHA2DS2-VASc Score in AF-related Stroke Patients

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