Prestroke CHA2DS2-VASc score and severity of acute stroke in patients with atrial fibrillation: findings from RAF study

Acciarresi, M. et al. (2017) Prestroke CHA2DS2-VASc score and severity of acute stroke in patients with atrial fibrillation: findings from RAF study. Journal of Stroke and Cerebrovascular Diseases, 26(6), pp. 1363-1368. (doi: 10.1016/j.jstrokecerebrovasdis.2017.02.011) (PMID:28236595)

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.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Abdul-Rahim, Dr Azmil and Lees, Professor Kennedy
• Authors: Acciarresi, M., Paciaroni, M., Agnelli, G., Falocci, N., Caso, V., Becattini, C., Marcheselli, S., Rueckert, C., Pezzini, A., Morotti, A., Costa, P., Padovani, A., Csiba, L., Szabó, L., Sohn, S.-I., Tassinari, T., Abdul-Rahim, A. H., Michel, P., Cordier, M., Vanacker, P., Remillard, S., Alberti, A., Venti, M., D'Amore, C., Scoditti, U., Denti, L., Orlandi, G., Chiti, A., Gialdini, G., Bovi, P., Carletti, M., Rigatelli, A., Putaala, J., Tatlisumak, T., Masotti, L., Lorenzini, G., Tassi, R., Guideri, F., Martini, G., Tsivgoulis, G., Vadikolias, K., Liantinioti, C., Corea, F., Del Sette, M., Ageno, W., De Lodovici, M. L., Bono, G., Baldi, A., D'Anna, S., Sacco, S., Carolei, A., Tiseo, C., Imberti, D., Zabzuni, D., Doronin, B., Volodina, V., Consoli, D., Galati, F., Pieroni, A., Toni, D., Monaco, S., Baronello, M. M., Barlinn, K., Pallesen, L.-P., Kepplinger, J., Bodechtel, U., Gerber, J., Deleu, D., Melikyan, G., Ibrahim, F., Akhtar, N., Mosconi, M. G., and Lees, K. R.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Psychology & Neuroscience
• Journal Name: Journal of Stroke and Cerebrovascular Diseases
• Publisher: Elsevier
• ISSN: 1052-3057
• ISSN (Online): 1532-8511
• Published Online: 22 February 2017
• Copyright Holders: Copyright © 2017 National Stroke Association
• First Published: First published in Journal of Stroke and Cerebrovascular Diseases 26(6): 1363-1368
• Publisher Policy: Reproduced in accordance with the publisher copyright policy