Stroke prediction with CHA2DS2-VASc score in patients with mesenteric ischemia without atrial fibrillation-insights from a nationwide cohort

Abstract

Background: The current study sought to evaluate the accuracy of CHA₂DS₂-VASc score for ischemic stroke prediction in patients with mesenteric ischemia without atrial fibrillation (AF).

Methods: The study participants included patients aged ≥18years with a new diagnosis of mesenteric ischemia during hospitalization between January 1, 2000 and December 31, 2011. Individuals with atrial fibrillation (AF) or atrial flutter during the study period were excluded. The study participants were followed up until the ischemic stroke appeared or they were censored due to withdrawal from this program, mortality, or the end of the study period, whichever came first. Cox proportional hazards regression models were applied for ischemic stroke risk stratification in the study participants by CHA₂DS₂-VASc score. The c-statistic based on the receiver operating characteristic (ROC) analysis was applied to investigate the accuracy of CHA₂DS₂-VASc score for ischemic stroke risk discrimination.

Results: A total of 24039 study participants were enrolled. Ischemic stroke incidence increased from 1.54% in CHA₂DS₂-VASc score of 0 to 9.23% in CHA₂DS₂-VASc score of 6 or more. Moreover, the Kaplan-Meier curve with a log rank test demonstrated that patients with a higher CHA₂DS₂-VASc score were associated with an increased cumulative incidence rate of ischemic stroke during the follow-up period (p<0.001). The discriminatory performance of the CHA2DS2-VASc score resulted in C-statistics of 0.65(95% CI=0.63-0.66) for predicting ischemic stroke risk among patients with mesenteric ischemia without AF.

Conclusions: A higher CHA₂DS₂-VASc score is demonstrated to be associated with an increased risk of ischemic stroke among patients with mesenteric ischemia without comorbid AF.

Keywords: CHA(2)DS(2)-VASc score; Cohort; Ischemic stroke; Mesenteric ischemia.