CHADS2 and CHA2DS2-VASc Scores Predict the Risk of Ischemic Stroke Outcome in Patients with Interatrial Block without Atrial Fibrillation

Abstract

Aim: To evaluate the role of CHADS₂ and CHA₂DS₂-VASc scores in predicting the risk of ischemic stroke or transient ischemic attack (TIA) outcomes in patients with interatrial block (IAB) without a history of atrial fibrillation (AF).

Methods: A retrospective study was conducted, including 1,046 non-anticoagulated inpatients (612 males, 434 females; mean age: 63±10 years) with IAB and without AF. IAB was defined as P-wave duration ＞120 ms using a 12-lead electrocardiogram. CHADS₂ and CHA₂DS₂-VASc scores were retrospectively calculated. The primary outcomes evaluated were ischemic stroke or TIA.

Results: During the mean follow-up period of 4.9±0.7 years, 55 (5.3%) patients had an ischemic stroke or TIA. Receiver operating characteristic (ROC) curve analysis showed that the CHADS₂ score [area under the curve (AUC), 0.638; 95% confidence interval (CI), 0.562-0.715; P=0.001] and the CHA₂DS₂-VASc score (AUC, 0.671; 95% CI, 0.599-0.744; P＜0.001) were predictive of ischemic strokes or TIA. Cut-off point analysis showed that a CHADS₂ score ≥3 (sensitivity=0.455 and specificity=0.747) and a CHA₂DS₂-VASc score ≥4 (sensitivity=0.564 and specificity=0.700) provided the highest predictive value for ischemic stroke or TIA. The multivariate Cox regression analysis showed that CHADS₂ [hazard ratio (HR), 1.442; 95% CI, 1.171-1.774; P=0.001] and CHA₂DS₂-VASc (HR, 1.420; 95% CI, 1.203-1.677; P＜0.001) scores were independently associated with ischemic stroke or TIA following adjustment for smoking, left atrial diameter, antiplatelet agents, angiotensin inhibitors, and statins.

Conclusions: CHADS₂ and CHA₂DS₂-VASc scores may be predictors of risk of ischemic stroke or TIA in patients with IAB without AF.

Fig. 1.

Incidence of ischemic stroke or TIA based on the CHADS₂ (A) and CHA₂DS₂-VASc (B) scores

Fig. 2.

Receiver operating characteristic (ROC) curves for the CHADS₂ (A) and CHA₂DS₂-VASc (B) scores for prediction of ischemic stroke or TIA

Fig. 3.

Kaplan–Meier curves showing the incidence of ischemic stroke or TIA stratified by CHADS₂ and CHA₂DS₂-VASc scores; A: Patients with a CHADS₂ score ≥ 3 had a higher incidence of ischemic stroke or TIA than those with a CHADS₂ score <3 (P = 0.001). B: Patients with a CHA₂DS₂-VASc score ≥ 4 had a higher incidence of ischemic stroke or TIA than those with a CHA₂DS₂-VASc score <4 (P <0.001).