1
|
Sakai K, Suda S, Iguchi Y, Abe A, Yagita Y, Kanzawa T, Okubo S, Fujimoto S, Kimura K. High pre-stroke CHADS 2 score predicts unfavorable functional outcome in acute cardioembolic stroke patients prescribed oral anticoagulant therapy: A sub-analysis of the PASTA registry study. J Stroke Cerebrovasc Dis 2024; 33:107519. [PMID: 38142567 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 12/26/2023] Open
Abstract
BACKGROUND AND PURPOSE The impact of CHADS2 score on outcome in patients with stroke taking an oral anticoagulant (OAC) has not yet been fully elucidated. We investigated the association between pre-stroke CHADS2 score and outcome at discharge in patients with acute cardioembolic (CE) stroke due to atrial fibrillation (AF) who were prescribed OAC. METHODS The data of 548 OAC-treated patients with AF and CE stroke who were registered in the multicenter Prospective Analysis of Stroke patients Taking oral Anticoagulants (PASTA) study were analyzed. High CHADS2 score was defined as a pre-stroke CHADS2 score ≥2. Unfavorable outcome was defined as a modified Rankin scale (mRS) of 3-6. The impacts of pre-stroke CHADS2 score on outcome at discharge were evaluated using multiple logistic regression analysis. RESULT A high CHADS2 score was found in 472/548 patients and unfavorable outcome was found in 330/548 patients. In patients with unfavorable outcome, age, male sex, pre-stroke CHADS2 score, initial National Institute Health Stroke Scale (NIHSS) score, and glucose level on admission were significantly higher, whereas creatinine clearance and body weight were significantly lower, than those with favorable outcome (each p < 0.001). Multivariate logistic regression analysis indicated that high CHADS2 score (OR 2.18, 95 %CI 1.08-4.42, p = 0.031), pre-stroke mRS (OR 2.21, 95 %CI 1.69-2.67, p < 0.001), and initial NIHSS score (OR 1.19, 95 %CI 1.17-1.24, p < 0.001) were independently associated with unfavorable outcome. CONCLUSION Pre-stroke CHADS2 score was associated with poor outcome in patients with cardioembolic stroke due to AF, even in those taking OAC.
Collapse
Affiliation(s)
- Kenichiro Sakai
- Department of Neurology, The Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo 105-0003, Japan.
| | - Satoshi Suda
- Department of Neurology, Nippon Medical School, Tokyo, Japan; Department of Neurology and Cerebrovascular Medicine, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yasuyuki Iguchi
- Department of Neurology, The Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo 105-0003, Japan
| | - Arata Abe
- Department of Neurology and Stroke Medicine, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Yoshiki Yagita
- Department of Stroke Medicine, Kawasaki Medical School, Okayama, Japan
| | - Takao Kanzawa
- Department of Stroke Medicine, Institute of Brain and Blood Vessels, Mihara Memorial Hospital, Gunma, Japan and Institute of HM Network, Gunyukai Isesaki Clinic, Gunma, Japan
| | - Seiji Okubo
- Department of Cerebrovascular Medicine, NTT Medical Center Tokyo, Tokyo, Japan
| | - Shigeru Fujimoto
- Division of Neurology, Department of Medicine, Jichi Medical University Hospital, Tochigi, Japan
| | - Kazumi Kimura
- Department of Neurology, Nippon Medical School, Tokyo, Japan
| |
Collapse
|
2
|
Yaşar E, Akalın Y, Aktaş İ, Çakmak T, Karakuş Y, Bayramoğlu A. The CHA2DS2-VASc risk score predicts successful endovascular treatment in patients with acute ischemic stroke. Acta Neurol Scand 2022; 145:407-413. [PMID: 34862802 DOI: 10.1111/ane.13564] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/01/2021] [Accepted: 11/24/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Acute ischemic stroke is a common cause of mortality and morbidity worldwide. Percutaneous endovascular intervention is an important treatment method in ischemic stroke. Endovascular procedure success is associated with the clinical outcome of the patients. The CHA2DS2-VASC score is an important score used to determine the risk of ischemic stroke in patients with atrial fibrillation. In our study, we aimed to evaluate the relationship between procedure success and CHA2DS2-VASC score in patients with acute ischemic stroke who underwent endovascular intervention. MATERIALS AND METHODS A total of 102 consecutive patients who underwent endovascular intervention with acute ischemic stroke were included in the study. The admission CHA2DS2-VASc scores of the patients were recorded. After the procedure, the relationship between the TICI score and the CHA2DS2-VASc score was evaluated. RESULTS CHA2DS2-VASc score was significantly higher in the group that resulted in unsuccessful endovascular intervention (2.78 ± 1.44, 5.02 ± 1.77 p < .001). Receiver-operating characteristics analysis revealed the cutoff value of CHA2DS2-VASc score ≥3 as a predictor of unsuccessful intervention with 76,6% sensitivity and 83,3% specificity, positive predictive value 50%, negative predictive value 84,6% (area under the curve [AUC]: 0.827,95% CI: 0.739-0.895, p < .001). In the multivariate analysis; atrial fibrillation ([β] = 4.201; [CI]: 1.251-14.103, p = .020), CHA2DS2-VASc score ([β] = 0.053; [CI]: 0.004-0.750, p = .030) were found independent predictors for unsuccessful intervention treatment. CONCLUSIONS In our study, we showed that the CHA2DS2-VASc score is associated with the success of endovascular intervention in patients with acute ischemic stroke who underwent percutaneous endovascular treatment.
Collapse
Affiliation(s)
- Erdoğan Yaşar
- Department of Cardiology Malatya Training and Research Hospital Malatya Turkey
| | - Yahya Akalın
- Department of Neurology Malatya Training and Research Hospital Malatya Turkey
| | - İbrahim Aktaş
- Department of Cardiology Malatya Training and Research Hospital Malatya Turkey
| | - Tolga Çakmak
- Department of Cardiology Malatya Training and Research Hospital Malatya Turkey
| | - Yasin Karakuş
- Department of Cardiology Malatya Training and Research Hospital Malatya Turkey
| | - Adil Bayramoğlu
- Department of Cardiology Faculty of Medicine İnönü University Malatya Turkey
| |
Collapse
|
3
|
Yaşar E, Bayramoğlu A, Karakuş Y, Çakmak T. The CHA2DS2-VASc Risk Score Predicts Total Occlusion in Infarct-Related Arteries in Patients With Non-ST Elevation Myocardial Infarction. Angiology 2021; 73:380-386. [PMID: 34275378 DOI: 10.1177/00033197211031324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Early detection of total coronary artery occlusion (TO) in non-ST elevation myocardial infarction (NSTEMI) patients may be beneficial since invasive treatments are initiated more rapidly in appropriate patients. Previous studies have shown that the CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, previous stroke, vascular disease, age between 65 and 74 years, female gender) score is associated with thrombus burden in acute coronary syndromes. We investigated the association between the CHA2DS2-VASc risk score and TO in patients with NSTEMI who underwent coronary angiography. TIMI (thrombolysis in myocardial infarction) flow 0 was defined as TO and TIMI flow 1-3 was defined as non-total occlusion (non-TO). The NSTEMI patients (n = 400) included were separated into two groups: those with (n = 138) and without (n = 262) TO. We observed that the CHA2DS2-VASc score was higher in the TO group (3.86 ± 2.32 vs 2.15 ± 1.79, P <.001). The Global Registry of Acute Coronary Events (GRACE) score (P = .002) and the CHA2DS2-VASc score (P < .001) were also found to be significant independent predictors for total occlusion in multiple regression analysis. A CHA2DS2-VASc score ≥3 had 68.1% sensitivity and 64.0% specificity (area under the curve (AUC): 0.657, 95% CI: 0.585-0.725, P < .001) for predicting TO. The CHA2DS2-VASc score was an effective tool that predicted TO in patients with NSTEMI.
Collapse
Affiliation(s)
- Erdoğan Yaşar
- Department of Cardiology, 506082Malatya Training and Research Hospital, Malatya, Turkey
| | - Adil Bayramoğlu
- Faculty of Medicine, Department of Cardiology, 175667İnönü University, Turkey
| | - Yasin Karakuş
- Department of Cardiology, 506082Malatya Training and Research Hospital, Malatya, Turkey
| | - Tolga Çakmak
- Department of Cardiology, 506082Malatya Training and Research Hospital, Malatya, Turkey
| |
Collapse
|
4
|
Stroke Risk Scores as Predictors of Severe Outcomes in Atrial Fibrillation: A Comprehensive Review. Am J Ther 2021; 28:e319-e334. [PMID: 33852487 DOI: 10.1097/mjt.0000000000001357] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most frequent sustained arrhythmia. It increases the risk of stroke, heart failure, death, hospitalizations, and costs. AREA OF UNCERTAINTY Several scores were introduced to stratify the stroke risk and need for anticoagulation in patients (pts) with AF . CHA2DS2-VASc, the most frequently used score, as well as other stroke risk scores have been additionally applied to estimate outcomes for different other conditions, with inhomogeneous results. To date, there has been no consensus regarding the usefulness of these scores to estimate outcomes outside of thromboembolic risk assessment, and their value in estimating different end-point outcomes is still a subject of debate. We conducted this review to investigate whether the stroke risk scores' utility can be extended for the prediction of other severe outcomes in pts with AF. DATA SOURCES We searched PubMed database and included studies that stratified the outcome of pts with AF by different stroke risk scores. We also included studies with a separate analysis of the pts with AF subpopulation. RESULTS Mortality rates increased with higher CHADS2 [from 2.28% (2.00%-2.58%) to 13.2% (8.24%-20.8%) per year] and CHA2DS2-VASc scores [risk ratio 1.26 (1.21-1.32), P < 0.0001 for score ≥3]. CHADS2 and CHA2DS2-VASc predicted poor outcome in stroke [odds ratio (OR) ranging 1.42-6 for CHADS2 and 1.3-7.3 for CHA2DS2-VASc]. Acute myocardial infarction rates increased with higher CHADS2 [OR 2.120 (1.942-2.315) P < 0.001] and CHA2DS2-VASc [OR 1.63 (1.53-1.75), P < 0.001]. Limited data were reported for ABC( Age, Biomarkers, Clinical histoty) and R2CHADS2. No statistically significant correlation was found for major bleeding. CONCLUSIONS CHADS2 and CHA2DS2-VASc are useful tools in identifying pts with AF at higher risk for all-cause death, regardless of other pathologies. Both scores correlated with the development of acute myocardial infarction, cardiovascular hospitalization, outcome in stroke, major adverse cardiovascular events, and major adverse cardiovascular and cerebral events, but not with serious bleeding.
Collapse
|
5
|
Wu HM, Chung CP, Lin YY. Similar thrombolysis outcomes in acute stroke patients with and without atrial fibrillation if pre-stroke CHA2DS2-VASc score is low: A retrospective study. Medicine (Baltimore) 2020; 99:e18680. [PMID: 31914063 PMCID: PMC6959866 DOI: 10.1097/md.0000000000018680] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
The prognosis of acute ischemic stroke patients treated with intravenous (IV) recombinant tissue plasminogen activator (rtPA) is poorer in patients with atrial fibrillation (AF) than patients without AF, which might be related to the greater stroke severity in AF patients. Higher pre-stroke CHA2DS2-VASc scores are associated with greater stroke severity and poorer outcomes. AF Patients tend to have higher CHA2DS2-VASc scores than the non-AF patients. We thus hypothesized that pre-stroke CHA2DS2-VASc scores can be used to improve outcome stratification of IV thrombolysis therapy in acute stroke patients with and without AF. We retrospectively enrolled ischemic stroke patients who received IV-rtPA and categorized them into 2 groups: low-risk (CHA2DS2-VASc scores ≤ 2) and high-risk (CHA2DS2-VASc scores ≥ 3) groups. We compared the outcomes between AF and non-AF patients and the interactive effects of the levels of CHA2DS2-VASc scores on this outcome difference. In the low-risk group, there was no difference in outcomes between the AF and non-AF patients. In the high-risk group, the AF patients had worse outcomes at 3 and 6 months. Our results suggest that pre-stroke CHA2DS2-VASc scores are a useful outcome predictor of IV thrombolytic therapy in acute stroke patients with AF.
Collapse
Affiliation(s)
- Hung-Ming Wu
- Institute of Brain Science
- Department of Neurology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Chih-Ping Chung
- Brain Research Center
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yung-Yang Lin
- Institute of Brain Science
- Brain Research Center
- Institute of Clinical Medicine
- Department of Critical Care Medicine
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital
| |
Collapse
|
6
|
Buck B, Okabe T, Guha A, Daoud E. CHA2DS2-VASc score predicts 30-day readmission due to thromboembolic complications following cardioversion of atrial fibrillation: insights from US National Readmissions Database. J Interv Card Electrophysiol 2019; 56:55-61. [DOI: 10.1007/s10840-019-00593-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 07/10/2019] [Indexed: 10/26/2022]
|
7
|
Tokunaga K, Yamagami H, Koga M, Todo K, Kimura K, Itabashi R, Terasaki T, Shiokawa Y, Kamiyama K, Takizawa S, Okuda S, Okada Y, Kameda T, Nagakane Y, Hasegawa Y, Shibuya S, Ito Y, Matsuoka H, Takamatsu K, Nishiyama K, Kario K, Yagita Y, Kitazono T, Kinoshita N, Takasugi J, Okata T, Yoshimura S, Sato S, Arihiro S, Toyoda K. Associations between Pre-Admission Risk Scores and Two-Year Clinical Outcomes in Ischemic Stroke or Transient Ischemic Attack Patients with Non-Valvular Atrial Fibrillation. Cerebrovasc Dis 2018; 45:170-179. [PMID: 29597211 DOI: 10.1159/000487896] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 02/22/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We aimed to clarify associations between pre-admission risk scores (CHADS2, CHA2DS2-VASc, and HAS-BLED) and 2-year clinical outcomes in ischemic stroke or transient ischemic attack (TIA) patients with non-valvular atrial fibrillation (NVAF) using a prospective, multicenter, observational registry. METHODS From 18 Japanese stroke centers, ischemic stroke or TIA patients with NVAF hospitalized within 7 days after onset were enrolled. Outcome measures were defined as death/disability (modified Rankin Scale score ≥3) at 2 years, 2-year mortality, and ischemic or hemorrhagic events within 2 years. RESULTS A total of 1,192 patients with NVAF (527 women; mean age, 78 ± 10 years), including 1,141 ischemic stroke and 51 TIA, were analyzed. Rates of death/disability, mortality, and ischemic or hemorrhagic events increased significantly with increasing pre-admission CHADS2 (p for trend <0.001 for death/disability and mortality, p for trend = 0.024 for events), CHA2DS2-VASc (p for trend <0.001 for all), and HAS-BLED (p for trend = 0.004 for death/disability, p for trend <0.001 for mortality, p for trend = 0.024 for events) scores. Pre-admission CHADS2 (OR per 1 point, 1.52; 95% CI 1.35-1.71; p <0.001 for death/disability; hazard ratio (HR) per 1 point, 1.23; 95% CI 1.12-1.35; p <0.001 for mortality; HR per 1 point, 1.14; 95% CI 1.02-1.26; p = 0.016 for events), CHA2DS2-VASc (1.55, 1.41-1.72, p < 0.001; 1.21, 1.12-1.30, p < 0.001; 1.17, 1.07-1.27, p < 0.001; respectively), and HAS-BLED (1.33, 1.17-1.52, p < 0.001; 1.23, 1.10-1.38, p < 0.001; 1.18, 1.05-1.34, p = 0.008; respectively) scores were independently associated with all outcome measures. CONCLUSIONS In ischemic stroke or TIA patients with NVAF, all pre-admission risk scores were independently associated with death/disability at 2 years and 2-year mortality, as well as ischemic or hemorrhagic events within 2 years.
Collapse
Affiliation(s)
- Keisuke Tokunaga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hiroshi Yamagami
- Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kenichi Todo
- Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kazumi Kimura
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Ryo Itabashi
- Department of Stroke Neurology, Kohnan Hospital, Sendai, Japan
| | - Tadashi Terasaki
- Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Yoshiaki Shiokawa
- Departments of Neurosurgery and Stroke Center, Kyorin University School of Medicine, Mitaka, Japan
| | - Kenji Kamiyama
- Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan
| | - Shunya Takizawa
- Department of Neurology, Tokai University School of Medicine, Isehara, Japan
| | - Satoshi Okuda
- Department of Neurology, NHO Nagoya Medical Center, Nagoya, Japan
| | - Yasushi Okada
- Department of Neurology and Cerebrovascular Medicine, NHO Kyushu Medical Center, Fukuoka, Japan
| | - Tomoaki Kameda
- Division of Neurology, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | | | - Yasuhiro Hasegawa
- Department of Neurology, St Marianna University School of Medicine, Kawasaki, Japan
| | - Satoshi Shibuya
- Department of Neurology, South Miyagi Medical Center, Ogawara, Japan
| | - Yasuhiro Ito
- Department of Neurology, TOYOTA Memorial Hospital, Toyota, Japan
| | - Hideki Matsuoka
- Department of Cerebrovascular Medicine, NHO Kagoshima Medical Center, Kagoshima, Japan
| | - Kazuhiro Takamatsu
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan
| | - Kazutoshi Nishiyama
- Department of Neurology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Yoshiki Yagita
- Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Naoto Kinoshita
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Junji Takasugi
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takuya Okata
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Sohei Yoshimura
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Shoichiro Sato
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Shoji Arihiro
- Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | | |
Collapse
|
8
|
Su CH, Tsao TF, Chen AC, Chang KW, Yang YS, Ueng KC, Tsai CF. CHA 2 DS 2 -VASc scores for outcome prediction in acute ischaemic stroke. Eur J Clin Invest 2018; 48. [PMID: 29288496 DOI: 10.1111/eci.12884] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 12/25/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND The CHADS2 and CHA2 DS2 -VASc scores are clinical risk stratification instruments that are used clinically to assess the risk of stroke in patients with atrial fibrillation (AF). The aim of this study was to evaluate whether the prestroke CHADS2 and CHA2 DS2 -VASc scores could be useful for predicting infarction severity and long-term outcomes in patients with acute ischaemic stroke. MATERIALS AND METHODS This prospective study included all 1494 patients who had acute ischaemic stroke without haemorrhagic transformation which was evidenced with magnetic resonance (MR) imaging during hospitalization. Total infarction volume and arterial stenosis score were calculated based on MR imaging. National Institutes of Health Stroke Scale scores (NIHSSs) were obtained at admission and discharge by board-certified neurologists. The clinical outcomes were defined as composite endpoints of restroke and mortality and were recorded with the mean follow-up period of 37.5 months. RESULTS There were 195 (13.1%) patients with AF. The patients with AF had significantly higher median CHADS2 and CHA2 DS2 -VASc scores than the patients without AF (P < .001). Patients with higher CHADS2 and CHA2 DS2 -VASc scores had significantly higher total infarction volume, arterial stenosis score and NIHSS scores at discharge and poorer clinical outcomes. After adjusting for age, gender and AF, only CHA2 DS2 -VASc scores could predict both restroke and composite endpoints. CONCLUSIONS Prestroke CHA2 DS2 -VASc scores appear to have better clinical value for predicting the severity of infarction and long-term clinical outcomes in acute ischaemic stroke patients with and without AF.
Collapse
Affiliation(s)
- Chun-Hung Su
- Division of Cardiology, Department of Internal Medicine, Chung-Shan Medical University Hospital Taichung, Taichung, Taiwan.,Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Teng-Fu Tsao
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan.,School of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, Taiwan
| | - An-Chih Chen
- Division of Cardiology, Department of Internal Medicine, Chung-Shan Medical University Hospital Taichung, Taichung, Taiwan.,Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Kai-Wei Chang
- Division of Cardiology, Department of Internal Medicine, Chung-Shan Medical University Hospital Taichung, Taichung, Taiwan.,Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yi-Sun Yang
- Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung-Shan Medical University Hospital, Taichung, Taiwan
| | - Kwo-Chang Ueng
- Division of Cardiology, Department of Internal Medicine, Chung-Shan Medical University Hospital Taichung, Taichung, Taiwan.,Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chin-Feng Tsai
- Division of Cardiology, Department of Internal Medicine, Chung-Shan Medical University Hospital Taichung, Taichung, Taiwan.,Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| |
Collapse
|
9
|
Acciarresi M, Paciaroni M, Agnelli G, Falocci N, Caso V, Becattini C, Marcheselli S, Rueckert C, Pezzini A, Morotti A, Costa P, Padovani A, Csiba L, Szabó L, Sohn SI, Tassinari T, Abdul-Rahim AH, Michel P, Cordier M, Vanacker P, Remillard S, Alberti A, Venti M, D'Amore C, Scoditti U, Denti L, Orlandi G, Chiti A, Gialdini G, Bovi P, Carletti M, Rigatelli A, Putaala J, Tatlisumak T, Masotti L, Lorenzini G, Tassi R, Guideri F, Martini G, Tsivgoulis G, Vadikolias K, Liantinioti C, Corea F, Del Sette M, Ageno W, De Lodovici ML, Bono G, Baldi A, D'Anna S, Sacco S, Carolei A, Tiseo C, Imberti D, Zabzuni D, Doronin B, Volodina V, Consoli D, Galati F, Pieroni A, Toni D, Monaco S, Baronello MM, Barlinn K, Pallesen LP, Kepplinger J, Bodechtel U, Gerber J, Deleu D, Melikyan G, Ibrahim F, Akhtar N, Mosconi MG, Lees KR. Prestroke CHA 2DS 2-VASc Score and Severity of Acute Stroke in Patients with Atrial Fibrillation: Findings from RAF Study. J Stroke Cerebrovasc Dis 2017; 26:1363-1368. [PMID: 28236595 DOI: 10.1016/j.jstrokecerebrovasdis.2017.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 01/20/2017] [Accepted: 02/03/2017] [Indexed: 10/20/2022] Open
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.
Collapse
Affiliation(s)
- Monica Acciarresi
- Stroke Unit and Division of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy.
| | - Maurizio Paciaroni
- Stroke Unit and Division of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Giancarlo Agnelli
- Stroke Unit and Division of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Nicola Falocci
- Stroke Unit and Division of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Valeria Caso
- Stroke Unit and Division of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Cecilia Becattini
- Stroke Unit and Division of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Simona Marcheselli
- Neurologia d'urgenza e Stroke Unit, Istituto Clinico Humanitas, Rozzano, Milano, Italy
| | | | - Alessandro Pezzini
- Department of Clinical and Experimental Sciences, Neurology Unit, University "Health and Wealth" of Brescia, Brescia, Italy
| | - Andrea Morotti
- Department of Clinical and Experimental Sciences, Neurology Unit, University "Health and Wealth" of Brescia, Brescia, Italy
| | - Paolo Costa
- Department of Clinical and Experimental Sciences, Neurology Unit, University "Health and Wealth" of Brescia, Brescia, Italy
| | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, Neurology Unit, University "Health and Wealth" of Brescia, Brescia, Italy
| | - Laszló Csiba
- Stroke Unit, University of Debrecen, Debrecen, Hungary
| | - Lilla Szabó
- Stroke Unit, University of Debrecen, Debrecen, Hungary
| | - Sung-Il Sohn
- Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea
| | - Tiziana Tassinari
- Stroke Unit-Department of Neurology, Santa Corona Hospital, Pietra Ligure, Savona, Italy
| | - Azmil H Abdul-Rahim
- Medical School and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Patrik Michel
- Centre Cérébrovasculaire, Service de Neurologie, Département des Neurosciences Cliniques Centre Hopitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Maria Cordier
- Centre Cérébrovasculaire, Service de Neurologie, Département des Neurosciences Cliniques Centre Hopitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Peter Vanacker
- Department of Neurology, Born Bunge Institute, Antwerp University Hospital, Antwerp, Belgium
| | - Suzette Remillard
- Centre Cérébrovasculaire, Service de Neurologie, Département des Neurosciences Cliniques Centre Hopitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Andrea Alberti
- Stroke Unit and Division of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Michele Venti
- Stroke Unit and Division of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Cataldo D'Amore
- Stroke Unit and Division of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Umberto Scoditti
- Stroke Unit, Neuroscience Department, University of Parma, Parma, Italy
| | - Licia Denti
- Stroke Unit, Dipartimento Geriatrico Riabilitativo, University of Parma, Parma, Italy
| | - Giovanni Orlandi
- Clinica Neurologica, Azienda Ospedaliero-Universitaria, Pisa, Italy
| | - Alberto Chiti
- Clinica Neurologica, Azienda Ospedaliero-Universitaria, Pisa, Italy
| | - Gino Gialdini
- Clinica Neurologica, Azienda Ospedaliero-Universitaria, Pisa, Italy
| | - Paolo Bovi
- SSO Stroke Unit, UO Neurologia, DAI di Neuroscienze, AOUI Verona, Italy
| | - Monica Carletti
- SSO Stroke Unit, UO Neurologia, DAI di Neuroscienze, AOUI Verona, Italy
| | - Alberto Rigatelli
- SSO Stroke Unit, UO Neurologia, DAI di Neuroscienze, AOUI Verona, Italy
| | - Jukka Putaala
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Turgut Tatlisumak
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland; Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Luca Masotti
- Department of Internal Medicine, Cecina Hospital, Cecina, Livorno, Italy
| | - Gianni Lorenzini
- Department of Internal Medicine, Cecina Hospital, Cecina, Livorno, Italy
| | | | | | | | - Georgios Tsivgoulis
- Department of Neurology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece; International Clinic Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic; Second Department of Neurology, "Attikon" Hospital, University of Athens, School of Medicine, Athens, Greece
| | - Kostantinos Vadikolias
- Department of Neurology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Chrissoula Liantinioti
- Second Department of Neurology, "Attikon" Hospital, University of Athens, School of Medicine, Athens, Greece
| | - Francesco Corea
- UO Gravi Cerebrolesioni, San Giovanni Battista Hospital, Foligno, Italy
| | - Massimo Del Sette
- Stroke Unit, Department of Neurology, Sant'Andrea Hospital, La Spezia, Italy
| | - Walter Ageno
- Department of Internal Medicine, Insubria University, Varese, Italy
| | | | - Giorgio Bono
- Stroke Unit, Neurology, Insubria University, Varese, Italy
| | - Antonio Baldi
- Stroke Unit, Ospedale di Portogruaro, Portogruaro, Venice, Italy
| | | | - Simona Sacco
- Department of Neurology, University of L'Aquila, L'Aquila, Italy
| | - Antonio Carolei
- Department of Neurology, University of L'Aquila, L'Aquila, Italy
| | - Cindy Tiseo
- Department of Neurology, University of L'Aquila, L'Aquila, Italy
| | - Davide Imberti
- Department of Internal Medicine, Ospedale Civile di Piacenza, Piacenza, Italy
| | - Dorjan Zabzuni
- Department of Internal Medicine, Ospedale Civile di Piacenza, Piacenza, Italy
| | - Boris Doronin
- Municipal Budgetary Healthcare Institution of Novosibirsk, City Clinical Hospital #1, Novosibirsk, Russia
| | - Vera Volodina
- Municipal Budgetary Healthcare Institution of Novosibirsk, City Clinical Hospital #1, Novosibirsk, Russia
| | | | - Franco Galati
- Stroke Unit, Jazzolino Hospital, Vibo Valentia, Italy
| | - Alessio Pieroni
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Danilo Toni
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | | | | | - Kristian Barlinn
- Department of Neurology, Dresden University Stroke Center, Dresden, Germany
| | | | - Jessica Kepplinger
- Department of Neurology, Dresden University Stroke Center, Dresden, Germany
| | - Ulf Bodechtel
- Department of Neurology, Dresden University Stroke Center, Dresden, Germany
| | - Johannes Gerber
- Department of Neurology, Dresden University Stroke Center, Dresden, Germany
| | - Dirk Deleu
- Neurology, Hamad Medical Corporation, Doha, Qatar
| | | | | | | | - Maria Giulia Mosconi
- Stroke Unit and Division of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Kennedy R Lees
- Medical School and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| |
Collapse
|
10
|
CHA 2DS 2-VASC-AF 2 score accurately predicts moderate-to-severe acute neurological dysfunction in the course of first ever ischaemic stroke. Int J Cardiol 2017; 228:286-288. [PMID: 27865199 DOI: 10.1016/j.ijcard.2016.11.257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 11/06/2016] [Accepted: 11/10/2016] [Indexed: 11/22/2022]
|
11
|
Nelson S, Cloonan L, Kanakis AS, Fitzpatrick KM, Shideler KI, Perilla AS, Furie KL, Rost NS. Antecedent Aspirin Use Is Associated with Less Severe Symptoms on Admission for Ischemic Stroke. J Stroke Cerebrovasc Dis 2016; 25:2519-25. [PMID: 27444522 DOI: 10.1016/j.jstrokecerebrovasdis.2016.06.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/08/2016] [Accepted: 06/22/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Aspirin is known to reduce stroke risk; however, its role in reducing severity of ischemic syndrome is not clear. We sought to investigate the relationship between antecedent aspirin use and stroke severity in patients presenting with acute ischemic stroke (AIS). METHODS We retrospectively analyzed a prospectively collected database of consecutive AIS patients presenting to our center. Clinical characteristics (including antecedent aspirin use), imaging findings, and laboratory data were assessed in association with presenting stroke severity, as measured by the National Institutes of Health Stroke Scale (NIHSS). Logistic regression models were used to determine univariate and multivariate predictors of baseline NIHSS. RESULTS Of the 610 AIS patients with admission brain magnetic resonance imaging available for volumetric analysis of acute infarct size, 241 (39.5%) used aspirin prior to stroke onset. Antecedent aspirin use (P = .0005), history of atrial fibrillation (P < .0001), acute infarct volume (P < .0001), initial systolic blood pressure (P = .041), admission glucose level (P = .0027), and stroke subtype (P < .0001) were associated with presenting stroke severity in univariate analysis. Antecedent aspirin use (P < .0001), history of atrial fibrillation (P < .0002), acute infarct volume (P < .0001), systolic blood pressure (P = .038), and glucose level (P = .0095) remained independent predictors of NIHSS in multivariable analysis. CONCLUSIONS Antecedent aspirin use was independently associated with milder presenting stroke severity, even after accounting for acute infarct volume. While the underlying biology of this apparent protective relationship requires further study, patients at high risk of stroke may benefit from routine aspirin use.
Collapse
Affiliation(s)
- Sarah Nelson
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts.
| | - Lisa Cloonan
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Allison S Kanakis
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Kaitlin M Fitzpatrick
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Kelsey I Shideler
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Adriana S Perilla
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Karen L Furie
- Department of Neurology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Natalia S Rost
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| |
Collapse
|
12
|
Tanaka K, Yamada T, Torii T, Matsumoto S, Yoshimura T, Takase KI, Wakata Y, Nakashima N, Kira JI, Murai H. Clinical characteristics of atrial fibrillation-related cardioembolic stroke in patients aged 80 years or older. Geriatr Gerontol Int 2016; 17:708-713. [DOI: 10.1111/ggi.12773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 02/02/2016] [Accepted: 02/13/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Koji Tanaka
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Takeshi Yamada
- Department of Neurology; Saiseikai Fukuoka General Hospital; Fukuoka Japan
| | - Takako Torii
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
- National Cerebral and Cardiovascular Center; Suita, Osaka Japan
| | - Shoji Matsumoto
- Department of Neurology; Kokura Memorial Hospital; Kitakyushu Japan
| | - Takeo Yoshimura
- Department of Neurology; Fukuoka City Hospital; Fukuoka Japan
| | | | - Yoshifumi Wakata
- Medical Information Center; Kyushu University Hospital; Fukuoka Japan
| | - Naoki Nakashima
- Medical Information Center; Kyushu University Hospital; Fukuoka Japan
| | - Jun-ichi Kira
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Hiroyuki Murai
- Department of Neurological Therapeutics, Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| |
Collapse
|
13
|
Nezu T, Hosomi N, Kondo K, Aoki S, Matsumoto M, Kobayashi S. Greater Severity of Neurological Defects in Women Admitted With Atrial Fibrillation-Related Stroke. Circ J 2015; 80:250-5. [PMID: 26511462 DOI: 10.1253/circj.cj-15-0873] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The magnitude of the CHA2DS2-VASc score is associated with not only stroke incidence but also long-term outcomes. The association between sex and initial stroke severity in AF-related cardioembolic stroke patients has not been clarified. The present study aimed to elucidate the risk factors for initial stroke severity among patients with cardioembolic stroke enrolled in a multicenter registry. METHODS AND RESULTS We selected 12,701 patients (age, 77±10 years; 5,653 women) with AF-related cardioembolic stroke from the Japan Standard Stroke Registry Study between January 2000 and July 2013. Indicators of National Institutes of Health Stroke Scale (NIHSS) scores at admission were identified using a multiple linear regression. Increased NIHSS scores positively correlated with CHA2DS2-VASc score (ρ=0.197; P<0.001). The initial neurological deficits were more severe in women than in men (NIHSS scores, median [interquartile range] 14 [5-22] vs. 8 [3-18]; P<0.001). Multiple regression analysis revealed that higher age (standardized partial regression coefficient [β] 0.162; P<0.001), female sex (β 0.120; P<0.001), diabetes mellitus (β 0.020; P=0.019), dyslipidemia (β -0.076; P<0.001), congestive heart failure (β 0.039; P<0.001), vascular disease (β 0.030; P=0.001), prior stroke/TIA (β 0.085; P<0.001) and prior anticoagulant use (β -0.020; P=0.028) were associated with the NIHSS score at admission. CONCLUSIONS Female sex was independently associated with the initial neurological severity among AF-related cardioembolic stroke patients.
Collapse
Affiliation(s)
- Tomohisa Nezu
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical & Health Sciences
| | | | | | | | | | | | | |
Collapse
|
14
|
Tanaka K, Yamada T, Torii T, Furuta K, Matsumoto S, Yoshimura T, Takase KI, Wakata Y, Nakashima N, Kira JI, Murai H. Pre-admission CHADS2, CHA2DS2-VASc, and R2CHADS2 Scores on Severity and Functional Outcome in Acute Ischemic Stroke with Atrial Fibrillation. J Stroke Cerebrovasc Dis 2015; 24:1629-35. [PMID: 25906940 DOI: 10.1016/j.jstrokecerebrovasdis.2015.03.036] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 03/19/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND We examined the association between pre-admission risk scores and severity on admission and functional outcome in acute ischemic stroke with atrial fibrillation (AF). METHODS Between September 2011 and April 2014, we retrospectively extracted consecutive ischemic stroke patients with AF whose pre-admission modified Rankin Scale (mRS) score was 2 or less from our prospective database. Pre-admission CHADS2, CHA2DS2-VASc, and R2CHADS2 scores were calculated in each patient, and their association with the National Institutes of Health Stroke Scale (NIHSS) score on admission or unfavorable outcome (mRS ≥ 3 at 3 months from the onset) was assessed. RESULTS A total of 344 patients (189 were men; age, 77.7 ± 10.0 years) were included in the analysis. The median pre-admission CHADS2, CHA2DS2-VASc, and R2CHADS2 scores were 2, 4, and 4, respectively. NIHSS score on admission was positively correlated with pre-admission CHADS2 (ρ = .116, P = .031), CHA2DS2-VASc (ρ = .166, P = .020), and R2CHADS2 scores (ρ = .106, P = .049). Receiver operating characteristic (ROC) curve analysis revealed that pre-admission CHADS2 score of 2 or more (sensitivity, 80%; specificity, 45%; area under the ROC curve [AUC], .654), CHA2DS2-VASc score of 3 or more (sensitivity, 86%; specificity, 44%; AUC, .683), and R2CHADS2 score of 4 or more (sensitivity, 61%; specificity, 62%; AUC, .657) were associated with unfavorable outcome. The pre-admission CHA2DS2-VASc score was better than the pre-admission CHADS2 score in estimating unfavorable outcome (P = .017). In multivariate analysis, cutoffs of these scores, female sex, higher NIHSS score, and internal carotid artery occlusion were associated with unfavorable outcome. CONCLUSIONS Pre-admission CHADS2, CHA2DS2-VASc, and R2CHADS2 scores were associated with onset severity and functional outcome in acute ischemic stroke with AF.
Collapse
Affiliation(s)
- Koji Tanaka
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takeshi Yamada
- Department of Neurology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Takako Torii
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Konosuke Furuta
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Neurology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Shoji Matsumoto
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Takeo Yoshimura
- Department of Neurology, Fukuoka City Hospital, Fukuoka, Japan
| | | | - Yoshifumi Wakata
- Medical Information Center, Kyushu University Hospital, Fukuoka, Japan
| | - Naoki Nakashima
- Medical Information Center, Kyushu University Hospital, Fukuoka, Japan
| | - Jun-ichi Kira
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroyuki Murai
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| |
Collapse
|
15
|
Sakamoto Y, Sato S, Hama Y, Nagatsuka K, Minematsu K, Toyoda K. The relationship between the pre-admission CHA2DS2-VASc score and proximal artery occlusion in patients with acute stroke and atrial fibrillation. Eur J Neurol 2015; 22:1081-7. [DOI: 10.1111/ene.12711] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 02/06/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Y. Sakamoto
- Department of Cerebrovascular Medicine; National Cerebral and Cardiovascular Center; Suita Japan
| | - S. Sato
- Department of Cerebrovascular Medicine; National Cerebral and Cardiovascular Center; Suita Japan
| | - Y. Hama
- Department of Cerebrovascular Medicine; National Cerebral and Cardiovascular Center; Suita Japan
| | - K. Nagatsuka
- Department of Neurology; National Cerebral and Cardiovascular Center; Suita Japan
| | - K. Minematsu
- Department of Cerebrovascular Medicine; National Cerebral and Cardiovascular Center; Suita Japan
| | - K. Toyoda
- Department of Cerebrovascular Medicine; National Cerebral and Cardiovascular Center; Suita Japan
| |
Collapse
|
16
|
Gołąb-Janowska M, Meller A, Kotlęga D, Bajer-Czajkowska A, Nowacki P. Atrial fibrillation and stroke - Coexistence and attitude to preventive therapy on the basis of Szczecin and Szczecin region patients. Neurol Neurochir Pol 2014; 48:410-5. [PMID: 25482252 DOI: 10.1016/j.pjnns.2014.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 10/03/2014] [Accepted: 10/09/2014] [Indexed: 11/18/2022]
Abstract
Atrial fibrillation (AF) is an independent factor increasing the risk of an ischemic stroke (IS) fivefold. The objective of the study was to evaluate the frequency of coexistence of non-valvular AF and IS during the acute stroke and to analyze the attitude of AF patients to treatment. The study included 3712 successive patients presenting either an IS or a transient ischemic attack. The analysis revealed a significant increase in the rate of patients with AF and IS in the years 2010-2013 (31.9%) compared with 2002-2005 (20.2%). A rise in the proportion of AF and IS patients was recorded over the course of consecutive years in group II. The proportion of newly detected AF cases during hospital stay differed significantly between the groups (16.9% vs. 31.9%). Group I and II patients differed essentially with regards to hypertension incidence and female rates. Antiplatelet medications or OACs were taken by a significantly greater number of AF patients in group II. Low number of therapeutic levels of INR was recorded in both groups. IS and AF coexist more frequently than indicated by previous assessments and demographic data from other countries. Increase in the number of IS and AF patients may result from higher detectability of AF and older age of patients affected with stroke, women in particular. Despite a well grounded knowledge about the benefits of OACs use in the prophylaxis of thrombotic-embolic events in AF patients, they are rarely used. A surprisingly low proportion of patients taking OACs reaches a therapeutic INR level.
Collapse
Affiliation(s)
| | - Agnieszka Meller
- Department of Neurology, Pomeranian Medical University, Szczecin, Poland
| | - Dariusz Kotlęga
- Department of Neurology, Pomeranian Medical University, Szczecin, Poland
| | | | - Przemysław Nowacki
- Department of Neurology, Pomeranian Medical University, Szczecin, Poland
| |
Collapse
|
17
|
Deguchi I, Fukuoka T, Hayashi T, Maruyama H, Sehara Y, Kato Y, Horiuchi Y, Nagamine Y, Sano H, Tanahashi N. Clinical Outcomes of Persistent and Paroxysmal Atrial Fibrillation in Patients with Stroke. J Stroke Cerebrovasc Dis 2014; 23:2840-2844. [DOI: 10.1016/j.jstrokecerebrovasdis.2014.07.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 07/03/2014] [Accepted: 07/08/2014] [Indexed: 11/26/2022] Open
|
18
|
Potpara TS, Polovina MM, Djikic D, Marinkovic JM, Kocev N, Lip GYH. The association of CHA2DS2-VASc score and blood biomarkers with ischemic stroke outcomes: the Belgrade stroke study. PLoS One 2014; 9:e106439. [PMID: 25184809 PMCID: PMC4153640 DOI: 10.1371/journal.pone.0106439] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 07/29/2014] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Many blood biomarkers have a positive association with stroke outcome, but adding blood biomarkers to the National Institutes of Health Stroke Scale (NIHSS) did not significantly improve its discriminatory ability. We investigated the association of the CHA2DS2-VASc score with unfavourable functional outcome (defined as a 30-day modified Rankin Scale [mRS] ≥ 3) in patients presenting with acute ischemic stroke (AIS), and examined whether the addition of blood biomarkers (troponin I [TnI], fibrinogen, C-reactive protein [CRP]) affects the model discriminatory ability. METHODS We conducted an observational single-centre study of consecutive patients with AIS. All patients were admitted to hospital within 24 hours from the neurological symptoms onset. RESULTS Of 240 patients (mean age 70.0 ± 8.9 years), unfavourable 30-day outcome occurred in 92 (38.3%). Patients with mRS ≥ 3 were older and more likely to have atrial fibrillation or other comorbidities (all p<0.001). They had higher levels of CRP, fibrinogen, TnI and higher CHA2DS2-VASc and CHADS2 scores (all p<0.05). The adjusted CHA2DS2-VASc score had excellent predictive ability for poor stroke outcome (c-statistic 0.982;95%CI,0.964-1.000, p<0.001). Whilst CRP had the highest sensitivity (83.7%), cardiac TnI was the most specific (97.3%) for prediction of poor stroke outcome (cut-off: >0.09 µg/L). Compared with each of these biomarkers, CHA2DS2-VASc score had significantly better predictive ability for poor stroke outcome (c-statistic for CRP, Fibrinogen and TnI was 0.853;95%CI,0.802-0.895, 0.848;95%CI,0.796-0.891, and 0.792;95%CI,0.736-0.842, all p<0.001, respectively, versus 0.932;95%CI,0.892-0.960, p<0.001 for the CHA2DS2-VASc, all p for the comparisons<0.01). There was no significant difference in the predictive ability of the CHA2DS2-VASc score vs. combinations of the CHA2DS2-VASc and TnI or TnI, fibrinogen and CRP (z statistic 0.369, p = 0.7119; integrated discrimination index 0.00801 and 0.00172, respectively, both p>0.05). CONCLUSIONS The CHA2DS2-VASc score alone reliably predicts 30-day unfavourable outcome of stroke. Adding blood biomarkers to the CHA2DS2-VASc score did not significantly increase the predictive ability of the model.
Collapse
Affiliation(s)
- Tatjana S. Potpara
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | | | - Dijana Djikic
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
- University Clinical Centre Gracanica, Kosovo, Serbia
| | - Jelena M. Marinkovic
- Institute for Medical Statistic and Informatic, University of Belgrade, Belgrade, Serbia
| | - Nikola Kocev
- Institute for Medical Statistic and Informatic, University of Belgrade, Belgrade, Serbia
| | - Gregory Y. H. Lip
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom
| |
Collapse
|
19
|
Falsetti L, Viticchi G, Tarquinio N, Silvestrini M, Capeci W, Balloni A, Catozzo V, Gentile A, Pellegrini F. CHA2DS2-VASc in the prediction of early atrial fibrillation relapses after electrical or pharmacological cardioversion. J Cardiovasc Med (Hagerstown) 2014; 15:636-41. [DOI: 10.2459/jcm.0000000000000139] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|