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Randomized Controlled Trial
. 2013 Jun;99(12):843-8.
doi: 10.1136/heartjnl-2013-303695. Epub 2013 Mar 28.

CHADS2 and CHA2DS2-VASc score to assess risk of stroke and death in patients paced for sick sinus syndrome

Jesper Hastrup Svendsen  1 , Jens Cosedis Nielsen, Stine Darkner, Gunnar Vagn Hagemann Jensen, Leif Spange Mortensen, Henning Rud Andersen; DANPACE Investigators
Affiliations
Free PMC article
Randomized Controlled Trial

CHADS2 and CHA2DS2-VASc score to assess risk of stroke and death in patients paced for sick sinus syndrome

Jesper Hastrup Svendsen et al. Heart. 2013 Jun.
Free PMC article

Abstract

Objective: The risk of stroke in patients with atrial fibrillation (AF) can be assessed by use of the CHADS2 and the CHA2DS2-VASc score system. We hypothesised that these risk scores and their individual components could also be applied to patients paced for sick sinus syndrome (SSS) to evaluate risk of stroke and death.

Design: Prospective cohort study.

Settings: All Danish pacemaker centres and selected centres in the UK and Canada.

Patients: Risk factors were recorded prior to pacemaker implantation in 1415 patients with SSS participating in the Danish Multicenter Randomized Trial on Single Lead Atrial Pacing versus Dual Chamber Pacing in Sick Sinus Syndrome (Danpace) trial. Development of stroke was assessed at follow-up visits and by evaluation of patient charts. Mortality was assessed from the civil registration system.

Interventions: Patients were randomised to AAIR (N = 707) or DDDR pacing (N = 708).

Main outcome measures: Stroke and death during follow-up.

Results: Mean follow-up was 4.3 ± 2.5 years. In the AAIR group 6.9% patients developed stroke versus 6.1% in the DDDR group (NS). There was a significant association between CHADS2 score and the development of stroke (HR 1.41; 95% CI 1.22 to 1.64, p < 0.001). CHA2DS2-VASc score was also significantly associated with stroke (HR 1.25; CI 1.12 to 1.40, p < 0.001). CHADS2 score (HR 1.46; CI 1.36 to 1.56, p < 0.001) and CHA2DS2-VASc score (HR 1.39; CI 1.31 to 1.46, p < 0.001) were associated with mortality. Results were still significant after adjusting for AF and anticoagulation therapy.

Conclusions: CHADS2 and CHA2DS2-VASc score are associated with increased risk of stroke and death in patients paced for SSS irrespective of the presence of AF.

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Figures

Figure 1
Figure 1
Cumulative stroke rate (%) during follow-up stratified according to (a) CHADS2 score, (b) age (A) and previous stroke/TIA (S2) from the CHADS2 score, (c) CHA2DS2-VASc score and (d) age (A2+A) and previous stroke/TIA/arterial embolism (S2) from the CHA2DS2-VASc score.
Figure 2
Figure 2
HRs for CHADS2 score and its association with stroke for all patients and patients without a history of atrial fibrillation (AF) at baseline (AF-free patients). C, NYHA class at baseline >1; H, medical treatment for hypertension; A, age≥75; D, diabetes; S2, previous stroke or TIA; AS2, A and S2 combined (A+S2); *Five patients with unknown NYHA at baseline counts as 0. **S2 takes the values 0 and 2. HR corresponds to an increase in S2 by 1.
Figure 3
Figure 3
HRs for CHA2DS2-VASc score and its association with stroke for all patients and patients without a history of atrial fibrillation (AF) at baseline (AF-free patients). C, NYHA class at baseline >1; H, medical treatment for hypertension; A2, age≥75; D, diabetes; S2, previous stroke, TIA or arterial embolism; V, vascular disease; A, age 65–75; Sc, (female) sex category; A2S2A, A2, S2 and A combined (A2+S2+A); *Patients with unknown NYHA or LVEF at baseline counts as 0. **For the sum of A2 and A. ***S2 takes the values 0 and 2. HR corresponds to an increase in S2 by 1.
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References

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