CHA2DS2-VASc risk factors as predictors of stroke after acute coronary syndrome: A systematic review and meta-analysis

Abstract

Background: Stroke is a rare but serious complication of acute coronary syndrome. At present, no specific score exists to identify patients at higher risk. The aim of the present study is to test whether each clinical variable included in the CHA₂DS₂-VASc score retains its predictive value in patients with recent acute coronary syndrome, irrespective of atrial fibrillation.

Methods: The meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. All clinical trials and observational studies presenting data on the association between stroke/transient ischemic attack incidence and at least one CHA₂DS₂-VASc item in patients with a recent acute coronary syndrome were considered in the analysis. Atrial fibrillation diagnosis was also considered.

Results: The whole cohort included 558,193 patients of which 7108 (1.3%) had an acute stroke and/or transient ischemic attack during follow-up (median nine months; 1^st-3^rd quartile 1-12 months). Age and previous stroke had the highest odds ratios (odds ratio 2.60; 95% confidence interval 2.21-3.06 and odds ratio 2.74; 95% confidence interval 2.19-3.42 respectively), in accordance with the two-point value given in the CHA₂DS₂-VASc score. All other factors were positively associated with stroke, although with lower odds ratios. Atrial fibrillation, while present in only 11.2% of the population, confirmed its association with an increased risk of stroke and/or transient ischemic attack (odds ratio 2.04; 95% confidence interval 1.71-2.44).

Conclusions: All risk factors included in the CHA₂DS₂-VASc score are associated with stroke/ transient ischemic attack in patients with recent acute coronary syndrome, and retain similar odds ratios to what already seen in atrial fibrillation. The utility of CHA₂DS₂-VASc score for risk stratification of stroke in patients with acute coronary syndrome remains to be determined.

Keywords: Acute coronary syndrome; atrial fibrillation; meta-analysis; risk stratification; stroke; thromboembolism.