CHA2DS2-VASc score as an independent outcome predictor in patients hospitalized with acute ischemic stroke

Chun-Hung Su; Chien-Hsien Lo; Hsin-Hung Chen; Chin-Feng Tsai; Hei-Tung Yip; Kai-Cheng Hsu; Chung Y Hsu; Chia-Hung Kao; Taiwan Stroke Registry Investigators

doi:10.1371/journal.pone.0270823

CHA2DS2-VASc score as an independent outcome predictor in patients hospitalized with acute ischemic stroke

PLoS One. 2022 Jul 13;17(7):e0270823. doi: 10.1371/journal.pone.0270823. eCollection 2022.

Authors

Chun-Hung Su^{1

2}, Chien-Hsien Lo^{1

2}, Hsin-Hung Chen^{1

3

4

5}, Chin-Feng Tsai^{1

2}, Hei-Tung Yip^{6

7}, Kai-Cheng Hsu^{7

8

9}, Chung Y Hsu¹⁰, Chia-Hung Kao^{10

11

12

13}; Taiwan Stroke Registry Investigators

Affiliations

¹ Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
² Division of Cardiology, Department of Internal Medicine, Chung-Shan Medical University Hospital, Taichung, Taiwan.
³ Division of Endocrinology and Metabolism, Department of Internal Medicine, Asia University Hospital, Taichung, Taiwan.
⁴ Chung Sheng Clinic, Nantou, Taiwan.
⁵ Department of Law, Providence University, Taichung, Taiwan.
⁶ Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
⁷ College of Medicine, China Medical University, Taichung, Taiwan.
⁸ Artificial Intelligence Center for Medical Diagnosis, China Medical University, Taichung, Taiwan.
⁹ Department of Neurology, China Medical University Hospital, Taichung, Taiwan.
¹⁰ Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan.
¹¹ Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.
¹² Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan.
¹³ Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung, Taiwan.

Abstract

Purpose: Atrial fibrillation (AF) is a significant independent risk factor for 1-year mortality in patients with first acute ischemic stroke (AIS). The CHA2DS2-VASc score was initially developed to assess the risk of stroke in patients with AF. Recently, this scoring system has been demonstrated to have clinical value for predicting long-term clinical outcomes in AIS but the evidence is insufficient. This large-scale prospective cohort study investigated the independent predictive value of the score in such patients.

Methods: We included patients with AIS from the Taiwan Stroke Registry (TSR) during 2006-2016 as the present study population. Patients were divided into those with high (≥2) and low (<2) CHA2DS2-VASc scores. We further analyzed and classified patients according to the presence of AF. The clinical endpoint was major adverse cardiac and cerebrovascular events (MACCEs) at 1 year after the index AIS.

Results: A total of 62,227 patients with AIS were enrolled. The median age was 70.3 years, and 59% of the patients were women. After confounding factors were controlled, patients with high CHA2DS2-VASc scores had significantly higher incidence of 1-year MACCEs (adjusted hazard ratio [HR] = 1.63; 95% confidence interval [CI] = 1.52, 1.76), re-stroke (adjusted HR = 1.28; 95% CI = 1.16, 1.42), and all-cause mortality (adjusted HR = 2.03; 95% CI = 1.83, 2.24) than those with low CHA2DS2-VASc scores did. In the comparison between AF and non-AF groups, the AF group had increased MACCEs (adjusted HR = 1.74; 95% CI = 1.60, 1.89), myocardial infarction (adjusted HR = 4.86; 95% CI = 2.07, 11.4), re-stroke (adjusted HR = 1.47; 95% CI = 1.26, 1.71), and all-cause mortality (adjusted HR = 1.90; 95% CI = 1.72, 2.10). The Kaplan-Meier curve revealed that both CHA2DS2-VASc scores and AF were independent risk predictors for 1-year MACCEs and mortality.

Conclusions: The CHA2DS2-VASc score and AF appeared to consistently predict 1-year MACCEs of AIS patients and provide more accurate risk stratification. Therefore, increased use of the CHA2DS2-VASc score may help improve the holistic clinical assessment of AIS patients with or without AF.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Atrial Fibrillation* / epidemiology
Female
Humans
Ischemic Stroke*
Male
Prospective Studies
Risk Assessment
Risk Factors
Stroke* / complications
Stroke* / diagnosis
Stroke* / epidemiology

Grants and funding

This study is supported in part by Taiwan Ministry of Health and Welfare Clinical Trial Center (MOHW110-TDU-B-212-124004), China Medical University Hospital (DMR-109-231, DMR-110-222, DMR-111-090, DMR-111-091, DMR-111-105); Ministry of Science and Technology (MOST 111-2321-B-039-005), Tseng-Lien Lin Foundation, Taichung, Taiwan. The funders had no role in the study design, data collection and analysis, the decision to publish, or preparation of the manuscript. No additional external funding was received for this study.