Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan.
Eur J Neurol. 2015 Jul;22(7):1081-7. doi: 10.1111/ene.12711. Epub 2015 Apr 9.
The CHA2DS2-VASc score is associated with severity and outcome of ischaemic stroke in patients with atrial fibrillation (AF). It was hypothesized that a high CHA2DS2-VASc score was related to severity and outcome because of its association with proximal artery occlusion (PAO). This study aimed to elucidate the relationship between the CHA2DS2-VASc score and PAO and to determine whether the effect of the CHA2DS2-VASc score on severity or outcome is independent of PAO.
Acute stroke patients with AF were retrospectively enrolled. PAO was defined as occlusion at the internal carotid artery or proximal middle cerebral artery on admission magnetic resonance angiography. Multivariable analyses were performed to identify independent factors associated with PAO and determine the associations of the CHA2DS2-VASc score with the initial National Institutes of Health Stroke Scale (NIHSS) score and poor functional outcome (discharge modified Rankin scale score 4-6).
In all, 213 patients [102 women; median age 80 (interquartile range 71-86) years; NIHSS score 16 (9-22)] were enrolled. On multivariable analysis, the CHA2DS2-VASc score (odds ratio 1.40, 95% confidence interval 1.12-1.76 per 1 point) was independently associated with PAO and correlated with the initial NIHSS score (standardized coefficient 0.198, P = 0.017). This association was not significant after further adjustment for PAO (0.080, P = 0.241). The CHA2DS2-VASc score was independently related to poor outcome even adjusted for PAO (odds ratio 1.39, 95% confidence interval 1.03-1.88).
The CHA2DS2-VASc score was associated with PAO in acute ischaemic stroke patients with AF. The CHA2DS2-VASc score may be correlated with the NIHSS score through the presence of PAO and with poor functional outcome independently of PAO.
CHA2DS2-VASc 评分与伴有心房颤动（AF）的缺血性脑卒中患者的严重程度和结局相关。该评分与近端动脉闭塞（PAO）相关，因此假设其与严重程度和结局相关。本研究旨在阐明 CHA2DS2-VASc 评分与 PAO 之间的关系，并确定 CHA2DS2-VASc 评分对严重程度或结局的影响是否独立于 PAO。
回顾性纳入急性脑卒中伴 AF 患者。PAO 定义为入院磁共振血管造影时颈内动脉或大脑中动脉近端闭塞。进行多变量分析以确定与 PAO 相关的独立因素，并确定 CHA2DS2-VASc 评分与初始国立卫生研究院脑卒中量表（NIHSS）评分和不良功能结局（出院改良 Rankin 量表评分 4-6）之间的相关性。
共纳入 213 例患者[102 例女性；中位年龄 80 岁（四分位距 71-86 岁）；NIHSS 评分 16 分（9-22 分）]。多变量分析显示，CHA2DS2-VASc 评分（每增加 1 分，比值比 1.40，95%置信区间 1.12-1.76）与 PAO 独立相关，与初始 NIHSS 评分相关（标准化系数 0.198，P=0.017）。进一步调整 PAO 后，该相关性无统计学意义（0.080，P=0.241）。即使调整了 PAO，CHA2DS2-VASc 评分与不良结局仍独立相关（比值比 1.39，95%置信区间 1.03-1.88）。
CHA2DS2-VASc 评分与急性缺血性脑卒中伴 AF 患者的 PAO 相关。CHA2DS2-VASc 评分可能通过 PAO 的存在与 NIHSS 评分相关，并且与 PAO 无关，与不良功能结局相关。
