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

Koji Tanaka, Takeshi Yamada, Takako Torii, Konosuke Furuta, Shoji Matsumoto, Takeo Yoshimura, Kei Ichiro Takase, Yoshifumi Wakata, Naoki Nakashima, Jun Ichi Kira, Hiroyuki Murai

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21 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)1629-1635
Number of pages7
JournalJournal of Stroke and Cerebrovascular Diseases
Volume24
Issue number7
DOIs
Publication statusPublished - 01-07-2015
Externally publishedYes

All Science Journal Classification (ASJC) codes

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

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