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. 2023 Aug;81(8):712-719.
doi: 10.1055/s-0043-1771167. Epub 2023 Aug 11.

Ischemic stroke risk factors not included in the CHADS-VASC score in patients with non-valvular atrial fibrillation

Laurine Le Goff  1 , Stanislas Demuth  2 , Andreas Fickl  3 , Lucian Muresan  1
Affiliations

Ischemic stroke risk factors not included in the CHADS-VASC score in patients with non-valvular atrial fibrillation

Laurine Le Goff et al. Arq Neuropsiquiatr. 2023 Aug.

Abstract
in English, Portuguese

Background: In patients with atrial fibrillation, the CHA2DS2-VASC score guides stroke prevention using anticoagulants, but it is an imperfect score. Other potential risk factors such as renal failure, the type of atrial fibrillation, active smoking, cancer, sleep apnea or systemic inflammation have less well been investigated.

Objective: To assess the impact of these factors on ischemic stroke risk in patients with non-valvular atrial fibrillation.

Methods: On a population of 248 patients (124 patients with acute ischemic stroke and 124 controls), we performed a logistic regression to assess the impact of multiple non-classic risk factors for the prediction of acute ischemic stroke. Their impact on mortality was assessed by performing a survival analysis.

Results: A high CHA2DS2-VASc score (OR 1.75; 95% CI 1.13-2.70; p = 0.032), treatment with anticoagulants (OR 0.19; 95% CI 0.07-0.51; p < 0.001) and permanent atrial fibrillation (OR 6.31; 95% CI 2.46-16.19; p < 0.001) were independently associated with acute ischemic stroke. Renal failure and chronic obstructive pulmonary disease predicted a higher mortality. After adjusting for age, sex, the CHA2DS2-VASc score and the use of anticoagulants, the only risk factor predictive for acute ischemic stroke was the permanent type of AF (OR: 8.0 [95% CI 2.5-25.5], p < 0.001).

Conclusions: The CHA2DS2-VASc score, the absence of anticoagulants and the permanent type of atrial fibrillation were the main predictive factors for the occurrence of acute ischemic stroke. Larger studies are necessary for conclusive results about other factors.

Antecedentes: Em pacientes com fibrilação atrial, o escore CHA2DS2-VASC orienta a prevenção de AVC com anticoagulantes, mas é um escore imperfeito. Outros fatores de risco potenciais, como insuficiência renal, o tipo de fibrilação atrial, tabagismo ativo, câncer, apnéia do sono ou inflamação sistêmica foram menos bem investigados.

Objetivo: Avaliar o impacto desses fatores no risco de AVC isquêmico em pacientes com fibrilação atrial não valvular. MéTODOS: Em uma população de 248 pacientes (124 pacientes com AVC isquêmico agudo e 124 controles), realizamos uma regressão logística para avaliar o impacto de múltiplos fatores de risco não clássicos na predição de AVC isquêmico agudo. O seu impacto na mortalidade foi avaliado através da realização de uma análise de sobrevivência.

Resultados: Escore CHA2DS2-VASc alto (OR 1,75; IC 95% 1,13–2,70; p = 0,032), tratamento com anticoagulantes (OR 0,19; IC 95% 0,07–0,51; p < 0,001) e fibrilação atrial permanente (OR 6,31; 95% CI 2,46–16,19; p < 0,001) foram independentemente associados ao AVC isquêmico agudo. Insuficiência renal e doença pulmonar obstrutiva crônica previram maior mortalidade. Após ajuste para idade, sexo, pontuação CHA2DS2-VASc e uso de anticoagulantes, o único fator de risco preditivo para AVC isquêmico agudo foi o tipo permanente de FA (OR: 8,0 [IC 95% 2,5–25,5], p < 0,001). CONCLUSõES: O escore CHA2DS2-VASc, a ausência de anticoagulantes e o tipo permanente de fibrilação atrial foram os principais fatores preditivos para a ocorrência de AVC isquêmico agudo. Estudos maiores são necessários para resultados conclusivos sobre outros fatores.

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Conflict of interest statement

There is no conflict of interest to declare.

Figures

Figure 1
Figure 1
Kaplan-Meyer curve showing the relation between the stage of renal insufficiency and global survival of patients in the AIS group (n = 127) displayed over 23 -months. The baseline was the date of AIS. Surviving patients were censored at the date of data collection.
Figure 2
Figure 2
Kaplan-Meyer curve showing the relation between COPD and global survival of patients in the AIS group (n = 127) displayed over 23 -months. The baseline was the date of AIS. Surviving patients were censored at the date of data collection.
See this image and copyright information in PMC

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