University Department of Medicine and Department of Neurology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Vic., Australia.
Cerebrovasc Dis. 2013;36(4):273-80. doi: 10.1159/000353670. Epub 2013 Oct 16.
CHADS2 and CHA2DS2-VASc scores are validated tools for assessing stroke risk in patients with atrial fibrillation (AF). We investigated whether these scores are associated with 3-month stroke outcomes and evaluated the utility of these scores in stratifying 3-month stroke outcomes in both patients with and without AF.
We analysed 6,612 acute ischaemic stroke patients from the Virtual International Stroke Trials Archive who received either placebo or ineffective active treatments not associated with significant cardiac complications. Outcomes included 3-month mortality, good functional outcomes defined as modified Rankin Scale score ≤1 and serious cardiac adverse events (SCAEs) defined as one of acute coronary syndrome, symptomatic heart failure, cardiopulmonary arrest, life-threatening arrhythmia and cardiac death. The association between the pre-stroke CHADS2 and CHA2DS2-VASc scores and 3-month stroke outcomes was assessed using binary logistic regression. The utility of the two scores in estimating 3-month stroke outcomes was assessed using area under the receiver operator characteristic curves (AUC) and compared using the χ(2) test.
In this cohort, 26.5% had AF, 35.3% received IV tissue plasminogen activator (tPA), 17.7% died, 25.1% achieved good functional outcomes and 9.5% had ≥1 SCAE at 3 months. High-risk (≥2) pre-stroke CHADS2 and CHA2DS2-VASc scores are both associated with 3-month mortality (CHADS2: odds ratio, OR, 2.33, 95% confidence interval 1.81-3.00; CHA2DS2-VASc: OR 3.01, 2.00-4.80), good functional outcomes (CHADS2: OR 0.47, 0.39-0.57; CHA2DS2-VASc: OR 0.55, 0.42-0.71) and SCAEs (CHADS2: OR 1.76, 1.28-2.42; CHA2DS2-VASc: OR 2.69, 1.53-4.73) after adjusting for baseline differences in neurological impairment, tPA use and AF. The pre-stroke CHA2DS2-VASc score is better than the CHADS2 score in estimating 3-month stroke outcomes in both patients with and without AF (p ≤ 0.005 in all AUC comparisons). High-risk pre-stroke CHA2DS2-VASc score has high sensitivity for mortality (AF: 0.96, 0.94-0.98; no AF: 0.88, 0.86-0.91) and negative predictive value for SCAE (AF: 0.93, 0.87-0.96; no AF: 0.96, 0.95-0.97) within 3 months. Low risk pre-stroke CHA2DS2-VASc score has high specificity for good functional outcome (AF: 0.99, 0.98-0.994; no AF: 0.94, 0.93-0.95) at 3 months.
The pre-stroke CHA2DS2-VASc score appears to be a simple tool for identifying patients at lower risk of poor outcomes and serious cardiac complications within 3 months following ischaemic stroke in patients with and without AF. © 2013 S. Karger AG, Basel.
CHADS2 和 CHA2DS2-VASc 评分是评估房颤（AF）患者中风风险的有效工具。我们研究了这些评分是否与 3 个月的中风结果相关，并评估了这些评分在分层 3 个月的中风结果方面的作用，包括有和没有 AF 的患者。
我们分析了来自虚拟国际中风试验档案的 6612 例急性缺血性中风患者，他们接受了安慰剂或与严重心脏并发症无关的无效活性治疗。结果包括 3 个月的死亡率、改良 Rankin 量表评分≤1 的良好功能结局和严重心脏不良事件（SCAE）定义为急性冠脉综合征、症状性心力衰竭、心肺骤停、威胁生命的心律失常和心脏死亡之一。使用二元逻辑回归评估了中风前 CHADS2 和 CHA2DS2-VASc 评分与 3 个月中风结果之间的关联。使用接收者操作特征曲线（ROC）下面积（AUC）评估了这两个评分在估计 3 个月中风结果中的效用，并使用 χ(2)检验进行比较。
在该队列中，26.5%的患者有 AF，35.3%的患者接受了 IV 组织型纤溶酶原激活剂（tPA）治疗，17.7%的患者死亡，25.1%的患者达到了良好的功能结局，9.5%的患者在 3 个月时有≥1 例 SCAE。中风前高风险（≥2）的 CHADS2 和 CHA2DS2-VASc 评分都与 3 个月的死亡率（CHADS2：优势比，OR，1.81-3.00；CHA2DS2-VASc：OR 2.00-4.80）、良好的功能结局（CHADS2：OR 0.47，0.39-0.57；CHA2DS2-VASc：OR 0.55，0.42-0.71）和 SCAE（CHADS2：OR 1.76，1.28-2.42；CHA2DS2-VASc：OR 2.69，1.53-4.73）相关，在调整了神经损伤、tPA 使用和 AF 的基线差异后。中风前的 CHA2DS2-VASc 评分在有和没有 AF 的患者中都优于 CHADS2 评分来估计 3 个月的中风结果（在所有 AUC 比较中 p ≤ 0.005）。中风前高风险的 CHA2DS2-VASc 评分对死亡率（AF：0.96，0.94-0.98；无 AF：0.88，0.86-0.91）和 SCAE 的阴性预测值（AF：0.93，0.87-0.96；无 AF：0.96，0.95-0.97）都有很高的敏感性。中风前低风险的 CHA2DS2-VASc 评分对 3 个月的良好功能结局（AF：0.99，0.98-0.994；无 AF：0.94，0.93-0.95）有很高的特异性。
在有和没有 AF 的缺血性中风患者中，中风前的 CHA2DS2-VASc 评分似乎是一种简单的工具，可以识别出在 3 个月内发生不良结局和严重心脏并发症风险较低的患者。
