Prestroke CHA2DS2-VASc Score and Severity of Acute Stroke in Patients with Atrial Fibrillation: Findings from RAF Study

Abstract

Background and purpose: The aim of this study was to investigate for a possible association between both prestroke CHA₂DS₂-VASc score and the severity of stroke at presentation, as well as disability and mortality at 90 days, in patients with acute stroke and atrial fibrillation (AF).

Methods: This prospective study enrolled consecutive patients with acute ischemic stroke, AF, and assessment of prestroke CHA₂DS₂-VASc score. Severity of stroke was assessed on admission using the National Institutes of Health Stroke Scale (NIHSS) score (severe stroke: NIHSS ≥10). Disability and mortality at 90 days were assessed by the modified Rankin Scale (mRS <3 or ≥3). Multiple logistic regression was used to correlate prestroke CHA₂DS₂-VASc and severity of stroke, as well as disability and mortality at 90 days.

Results: Of the 1020 patients included in the analysis, 606 patients had an admission NIHSS score lower and 414 patients higher than 10. At 90 days, 510 patients had mRS ≥3. A linear correlation was found between the prestroke CHA₂DS₂-VASc score and severity of stroke (P = .001). On multivariate analysis, CHA₂DS₂-VASc score correlated with severity of stroke (P = .041) and adverse functional outcome (mRS ≥3) (P = .001). A logistic regression with the receiver operating characteristic graph procedure (C-statistics) evidenced an area under the curve of .60 (P = .0001) for severe stroke. Furthermore, a correlation was found between prestroke CHA₂DS₂-VASc score and lesion size.

Conclusions: In patients with AF, in addition to the risk of stroke, a high CHA₂DS₂-VASc score was independently associated with both stroke severity at onset and disability and mortality at 90 days.

Keywords: CHA(2)DS(2)-VASc score; Ischemic stroke; atrial fibrillation; outcome; scores; severity.