CHA2DS2-VASc Score Is Associated With Prognosis in Patients With Acute Ischemic Stroke Without Atrial Fibrillation
Background: Although the prognostic value of the CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack, vascular disease, age 65-74 years, and female sex) scoring system in patients with stroke has been explored in several s...
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The Texas Heart Institute
2025-02-01
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| author | Mingjuan Song, MM Xu Chen, MD |
| author_facet | Mingjuan Song, MM Xu Chen, MD |
| author_sort | Mingjuan Song, MM |
| collection | DOAJ |
| description | Background:
Although the prognostic value of the CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack, vascular disease, age 65-74 years, and female sex) scoring system in patients with stroke has been explored in several studies, a research gap exists in its application, especially in patients without atrial fibrillation (AF).
Methods:
This study investigated the association between CHA2DS2-VASc score and prognosis at 1 year in patients with acute ischemic stroke (AIS) who do not have AF. A total of 993 patients with AIS but without AF were recruited between January 2019 and December 2022. Patients were categorized into high-risk (CHA2DS2-VASc score, >2; n = 424), moderate-risk (CHA2DS2-VASc score, 2; n = 218), and low-risk (CHA2DS2-VASc score, 0-1; n = 351) groups. The primary outcome was major adverse cardiac events (MACE) at 1 year after index AIS. Multivariate Cox regression analyses evaluated the prognostic value of CHA2DS2-VASc scores after controlling for potential confounding factors. A sensitivity analysis was performed based on 3 CHA2DS2-VASc groups generated using propensity score matching.
Results:
The rate of MACE during 12-month follow-up was statistically significantly higher (P < .01) in patients with a CHA2DS2-VASc score greater than 2 (34.7%) than in patients with a score of 2 (23.9%) or of 0 or 1 (14.8%). Multivariate Cox regression models indicated that, compared with a CHA2DS2-VASc score of 0 or 1, the hazard ratio (HR) of MACE occurrence was 3.22 (95% CI, 1.93-5.37; P < .01) for a CHA2DS2-VASc score greater than 2 and 1.92 (95% CI, 1.24-2.98; P < .01) for a CHA2DS2-VASc score of 2. When included in the Cox regression model as a continuous variable, the CHA2DS2-VASc score remained strongly associated with higher risks of MACE (HR, 1.19 [95% CI, 1.11-1.26]; P < .01), all-cause mortality (HR, 1.14 [95% CI, 1.05-1.23]; P < .01), and recurrent stroke (HR, 1.15 [95% CI, 1.06-1.256]; P < .01). Sensitivity analyses based on populations generated by propensity score matching yielded similar results.
Conclusion:
The CHA2DS2-VASc score effectively predicts MACE in patients with AIS but without AF, providing more accurate risk stratification. |
| format | Article |
| id | doaj-art-aad6f2233a2445908eb3a3f6b60464fc |
| institution | Kabale University |
| issn | 1526-6702 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | The Texas Heart Institute |
| record_format | Article |
| series | Texas Heart Institute Journal |
| spelling | doaj-art-aad6f2233a2445908eb3a3f6b60464fc2025-02-05T09:21:37ZengThe Texas Heart InstituteTexas Heart Institute Journal1526-67022025-02-015211810.14503/THIJ-24-8450i1526-6702-52-1-e248450CHA2DS2-VASc Score Is Associated With Prognosis in Patients With Acute Ischemic Stroke Without Atrial FibrillationMingjuan Song, MM0Xu Chen, MD11 School of Medicine, Jiangsu University, Jiangsu Province, China3 Department of Neurology, Shanghai Eighth People's Hospital, Xuhui District, Shanghai, ChinaBackground: Although the prognostic value of the CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack, vascular disease, age 65-74 years, and female sex) scoring system in patients with stroke has been explored in several studies, a research gap exists in its application, especially in patients without atrial fibrillation (AF). Methods: This study investigated the association between CHA2DS2-VASc score and prognosis at 1 year in patients with acute ischemic stroke (AIS) who do not have AF. A total of 993 patients with AIS but without AF were recruited between January 2019 and December 2022. Patients were categorized into high-risk (CHA2DS2-VASc score, >2; n = 424), moderate-risk (CHA2DS2-VASc score, 2; n = 218), and low-risk (CHA2DS2-VASc score, 0-1; n = 351) groups. The primary outcome was major adverse cardiac events (MACE) at 1 year after index AIS. Multivariate Cox regression analyses evaluated the prognostic value of CHA2DS2-VASc scores after controlling for potential confounding factors. A sensitivity analysis was performed based on 3 CHA2DS2-VASc groups generated using propensity score matching. Results: The rate of MACE during 12-month follow-up was statistically significantly higher (P < .01) in patients with a CHA2DS2-VASc score greater than 2 (34.7%) than in patients with a score of 2 (23.9%) or of 0 or 1 (14.8%). Multivariate Cox regression models indicated that, compared with a CHA2DS2-VASc score of 0 or 1, the hazard ratio (HR) of MACE occurrence was 3.22 (95% CI, 1.93-5.37; P < .01) for a CHA2DS2-VASc score greater than 2 and 1.92 (95% CI, 1.24-2.98; P < .01) for a CHA2DS2-VASc score of 2. When included in the Cox regression model as a continuous variable, the CHA2DS2-VASc score remained strongly associated with higher risks of MACE (HR, 1.19 [95% CI, 1.11-1.26]; P < .01), all-cause mortality (HR, 1.14 [95% CI, 1.05-1.23]; P < .01), and recurrent stroke (HR, 1.15 [95% CI, 1.06-1.256]; P < .01). Sensitivity analyses based on populations generated by propensity score matching yielded similar results. Conclusion: The CHA2DS2-VASc score effectively predicts MACE in patients with AIS but without AF, providing more accurate risk stratification.https://thij.kglmeridian.com/view/journals/thij/52/1/article-e248450.xmlprognosisischemic strokecardiovascular diseasesatrial fibrillation |
| spellingShingle | Mingjuan Song, MM Xu Chen, MD CHA2DS2-VASc Score Is Associated With Prognosis in Patients With Acute Ischemic Stroke Without Atrial Fibrillation Texas Heart Institute Journal prognosis ischemic stroke cardiovascular diseases atrial fibrillation |
| title | CHA2DS2-VASc Score Is Associated With Prognosis in Patients With Acute Ischemic Stroke Without Atrial Fibrillation |
| title_full | CHA2DS2-VASc Score Is Associated With Prognosis in Patients With Acute Ischemic Stroke Without Atrial Fibrillation |
| title_fullStr | CHA2DS2-VASc Score Is Associated With Prognosis in Patients With Acute Ischemic Stroke Without Atrial Fibrillation |
| title_full_unstemmed | CHA2DS2-VASc Score Is Associated With Prognosis in Patients With Acute Ischemic Stroke Without Atrial Fibrillation |
| title_short | CHA2DS2-VASc Score Is Associated With Prognosis in Patients With Acute Ischemic Stroke Without Atrial Fibrillation |
| title_sort | cha2ds2 vasc score is associated with prognosis in patients with acute ischemic stroke without atrial fibrillation |
| topic | prognosis ischemic stroke cardiovascular diseases atrial fibrillation |
| url | https://thij.kglmeridian.com/view/journals/thij/52/1/article-e248450.xml |
| work_keys_str_mv | AT mingjuansongmm cha2ds2vascscoreisassociatedwithprognosisinpatientswithacuteischemicstrokewithoutatrialfibrillation AT xuchenmd cha2ds2vascscoreisassociatedwithprognosisinpatientswithacuteischemicstrokewithoutatrialfibrillation |