Department of Neurology, Saitama International Medical Center, Saitama Medical University, Saitama, Japan.
J Stroke Cerebrovasc Dis. 2013 Nov;22(8):e343-6. doi: 10.1016/j.jstrokecerebrovasdis.2013.02.018. Epub 2013 Mar 20.
Whether the CHA(2)DS(2)-VASc score reflects severity or clinical outcomes in patients with an initial cardioembolic stroke associated with nonvalvular atrial fibrillation (NAVF) was investigated.
This study included 327 patients hospitalized between April 2007 and March 2012 for an initial cardioembolic stroke associated with NVAF with no history of stroke. The National Institutes of Health Stroke Scale (NIHSS) score on admission and clinical outcome (modified Rankin Scale [mRS] score after 90 days) were retrospectively evaluated according to the CHA(2)DS(2)-VASc score.
CHA(2)DS(2)-VASc scores were 0, 3.1%; 1, 9.1%; 2, 24.5%; 3, 26%; 4, 20.8%; 5, 14.4%; and 6, 2.1%. The median NIHSS scores for CHA(2)DS(2)-VASc scores of 0-6 were 4.5, 8, 8, 10, 11, 17, and 23, respectively. Severity differed according to the CHA(2)DS(2)-VASc score. The clinical outcomes according to the CHA(2)DS(2)-VASc scores were as follows: score 0, mRS scores of 0-2 (80%) and 3-6 (20%); score 1, mRS scores of 0-2 (80%) and 3-6 (20%); score 2, mRS scores of 0-2 (64%) and 3-6 (36%); score 3, mRS scores of 0-2 (48%) and 3-6 (52%); score 4, mRS scores of 0-2 (28%) and 3-6 (72%); score 5, mRS scores of 0-2 (26%) and 3-6 (74%); and score 6, mRS scores of 0-2 (29%) and 3-6 (71%). The clinical outcome worsened as the CHA(2)DS(2)-VASc score increased. On logistic regression analysis, age, NIHSS score on admission, and thrombolytic therapy were related to a clinical outcome.
The severity of NVAF-induced initial cardioembolic stroke increased with higher CHA(2)DS(2)-VASc scores, and the outcomes were poor. The present study suggests that the CHA(2)DS(2)-VASc score may be useful not only for the evaluation of stroke risk but also for the prediction of clinical outcomes after stroke.
本研究旨在探讨 CHA(2)DS(2)-VASc 评分是否反映了伴有非瓣膜性心房颤动（NVAF）的首发心源性脑卒患者的严重程度或临床结局。
本研究纳入了 2007 年 4 月至 2012 年 3 月期间因伴有 NVAF 的首发心源性脑卒住院的 327 例患者，这些患者均无卒中病史。根据 CHA(2)DS(2)-VASc 评分，回顾性评估入院时的 NIHSS 评分和临床结局（90 天后改良 Rankin 量表评分）。
CHA(2)DS(2)-VASc 评分为 0、3.1%、1、9.1%、2、24.5%、3、26%、4、20.8%、5、14.4%和 6、2.1%。CHA(2)DS(2)-VASc 评分 0-6 的中位数 NIHSS 评分分别为 4.5、8、8、10、11、17 和 23。严重程度根据 CHA(2)DS(2)-VASc 评分而有所不同。根据 CHA(2)DS(2)-VASc 评分，临床结局如下：评分 0 时，mRS 评分为 0-2（80%）和 3-6（20%）；评分 1 时，mRS 评分为 0-2（80%）和 3-6（20%）；评分 2 时，mRS 评分为 0-2（64%）和 3-6（36%）；评分 3 时，mRS 评分为 0-2（48%）和 3-6（52%）；评分 4 时，mRS 评分为 0-2（28%）和 3-6（72%）；评分 5 时，mRS 评分为 0-2（26%）和 3-6（74%）；评分 6 时，mRS 评分为 0-2（29%）和 3-6（71%）。随着 CHA(2)DS(2)-VASc 评分的升高，临床结局恶化。在 logistic 回归分析中，年龄、入院时 NIHSS 评分和溶栓治疗与临床结局相关。
NVAF 引起的首发心源性脑卒严重程度随 CHA(2)DS(2)-VASc 评分的升高而增加，且结局较差。本研究表明，CHA(2)DS(2)-VASc 评分不仅可用于评估卒中风险，还可用于预测卒中后的临床结局。
