Prestroke CHA2DS2-VASc Score and Severity of Acute Stroke in Patients with Atrial Fibrillation: Findings from RAF Study

Monica Acciarresi, Maurizio Paciaroni, Giancarlo Agnelli, Nicola Falocci, Valeria Caso, Cecilia Becattini, Simona Marcheselli, Christina Rueckert, Alessandro Pezzini, Andrea Morotti, Paolo Costa, Alessandro Padovani, Laszló Csiba, Lilla Szabó, Sung Il Sohn, Tiziana Tassinari, Azmil H. Abdul-Rahim, Patrik Michel, Maria Cordier, Peter VanackerSuzette Remillard, Andrea Alberti, Michele Venti, Cataldo D'Amore, Umberto Scoditti, Licia Denti, Giovanni Orlandi, Alberto Chiti, Gino Gialdini, Paolo Bovi, Monica Carletti, Alberto Rigatelli, Jukka Putaala, Turgut Tatlisumak, Luca Masotti, Gianni Lorenzini, Rossana Tassi, Francesca Guideri, Giuseppe Martini, Georgios Tsivgoulis, Kostantinos Vadikolias, Chrissoula Liantinioti, Francesco Corea, Massimo Del Sette, Walter Ageno, Maria Luisa De Lodovici, Giorgio Bono, Antonio Baldi, Sebastiano D'Anna, Simona Sacco, Antonio Carolei, Cindy Tiseo, Davide Imberti, Dorjan Zabzuni, Boris Doronin, Vera Volodina, Domenico Consoli, Franco Galati, Alessio Pieroni, Danilo Toni, Serena Monaco, Mario Maimone Baronello, Kristian Barlinn, Lars Peder Pallesen, Jessica Kepplinger, Ulf Bodechtel, Johannes Gerber, Dirk Deleu, Gayane Melikyan, Faisal Ibrahim, Naveed Akhtar, Maria Giulia Mosconi, Kennedy R. Lees

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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.

Original languageEnglish
Pages (from-to)1363-1368
Number of pages6
JournalJournal of Stroke and Cerebrovascular Diseases
Volume26
Issue number6
DOIs
Publication statusPublished - Jun 1 2017

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Keywords

  • atrial fibrillation
  • CHADS-VASc score
  • Ischemic stroke
  • outcome
  • scores
  • severity

ASJC Scopus subject areas

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

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., ... Lees, K. R. (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), 1363-1368. https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.02.011