Postoperative ischemic stroke and death prediction with CHA2DS2-VASc score in patients having coronary artery bypass grafting surgery: A nationwide cohort study

Abstract

Objectives: This nationwide cohort study was attempted to address the predictive ability of CHA2DS2-VASc score in both ischemic stroke and death in patients undergoing coronary artery bypass grafting (CABG) surgery.

Methods: We identified patients aged ≥18years undergoing de novo CABG between January 1, 2000 and December 31, 2011. We calculated CHA₂DS₂-VASc score for each study patient. We used univariable and multivariable Cox proportional hazards regression models to measure the hazard ratios (HRs) and 95% confidence intervals (CIs) for ischemic stroke and death associated with CHA₂DS₂-VASc score in the study patients. We used the area under the curve of receiver-operating characteristic (C-statistic) to calculate the predictive power of CHA₂DS₂-VASc score with respect to ischemic stroke and death in patients having CABG.

Results: A total of 43,694 patients aged ≥18years receiving de novo CABG were included in the study cohort. The incidence and risk of ischemic stroke and death were positively associated with CHA₂DS₂-VASc score in patients receiving CABG. In addition, the discriminatory properties of the score resulted in C-statistics of 0.60 (95% CI=0.59-0.61) and 0.63 (95% CI=0.62-0.64) for the prediction of ischemic stroke and death in patients undergoing CABG, respectively.

Conclusions: The present study is the first nationwide cohort study to investigate the performance of CHA₂DS₂-VASc score for the prediction of ischemic stroke and death in patients receiving CABG. However, the discriminative power was modest, and the predictive role of CHA₂DS₂-VASc score in this population remained to be determined.

Keywords: CHA(2)DS(2)-VASc score; Coronary artery bypass grafting; Death; Ischemic stroke.