Pre-admission CHADS₂, CHA₂DS₂-VASc, and R₂CHADS₂ scores on severity and functional outcome in acute ischemic stroke with atrial fibrillation

Background We examined the association between pre-admission risk scores and severity on admission and functional outcome in acute ischemic stroke with atrial fibrillation (AF). Methods Between September 2011 and April 2014, we retrospectively extracted consecutive ischemic stroke patients with AF whose pre-admission modified Rankin Scale (mRS) score was 2 or less from our prospective database. Pre-admission CHADS₂, CHA₂DS₂-VASc, and R₂CHADS₂ scores were calculated in each patient, and their association with the National Institutes of Health Stroke Scale (NIHSS) score on admission or unfavorable outcome (mRS ≥3 at 3 months from the onset) was assessed. Results A total of 344 patients (189 were men; age, 77.7 ± 10.0 years) were included in the analysis. The median pre-admission CHADS₂, CHA₂DS₂-VASc, and R₂CHADS₂ scores were 2, 4, and 4, respectively. NIHSS score on admission was positively correlated with pre-admission CHADS₂ (ρ =.116, P =.031), CHA₂DS₂-VASc (ρ =.166, P =.020), and R₂CHADS₂ scores (ρ =.106, P =.049). Receiver operating characteristic (ROC) curve analysis revealed that pre-admission CHADS₂ score of 2 or more (sensitivity, 80%; specificity, 45%; area under the ROC curve [AUC],.654), CHA₂DS₂-VASc score of 3 or more (sensitivity, 86%; specificity, 44%; AUC,.683), and R₂CHADS₂ score of 4 or more (sensitivity, 61%; specificity, 62%; AUC,.657) were associated with unfavorable outcome. The pre-admission CHA₂DS₂-VASc score was better than the pre-admission CHADS₂ score in estimating unfavorable outcome (P =.017). In multivariate analysis, cutoffs of these scores, female sex, higher NIHSS score, and internal carotid artery occlusion were associated with unfavorable outcome. Conclusions Pre-admission CHADS₂, CHA₂DS₂-VASc, and R₂CHADS₂ scores were associated with onset severity and functional outcome in acute ischemic stroke with AF.