Stroke Unit, Department of Neurosciences, Udine University-Hospital, Udine, Italy.
Stroke Unit, Department of Neurosciences, S. Maria della Misericordia University Hospital, Piazzale S. Maria della Misericordia 15, 33100, Udine, Italy.
J Thromb Thrombolysis. 2018 Jan;45(1):122-129. doi: 10.1007/s11239-017-1575-0.
The CHADS-VASc score is a validated tool to assess the thromboembolic risk in patients with atrial fibrillation. Pre-stroke CHADS-VASc score may predict outcome in patients with acute ischemic stroke (AIS) without atrial fibrillation. The aim of this study was to investigate if the pre-stroke CHADS-VASc score is able to predict short- and long-term outcomes in AIS patients treated with intravenous thrombolysis (IVT). The study group consisted of 256 consecutive patients admitted to the Udine University Hospital with AIS and underwent IVT between January 2015 to March 2017. The pre-stroke CHADS-VASc score for each patient was calculated from the collected baseline data. Patients were classified into three groups according to their pre-stroke CHADS-VASc score: a score of 0 of 1, a score of 2 or 3 and a score above 3. Primary outcome measures were: rate of favorable outcome at 90-days and at 1-year, and mortality at 90-days and at 1-year. Data on functional outcome and mortality 1 year after stroke were collected in 165 patients (65% of the entire sample). Favorable outcome was defined as a modified Rankin Scale score ≤ 2. Compared with the CHADS-VASc score 0-1 group, patients with higher CHADS-VASc scores had a worse outcome and a higher mortality 3 months and 1 year after stroke. The diagnostic performance of the CHADS-VASc score as judged with AUC-ROC was 0.70 (95% CI, 0.64-0.76; p < 0.001) for favorable outcome at 90-days, 0.78 (95% CI, 0.71-0.85; p < 0.001) for favorable outcome at 1-year, 0.71 (95% CI 0.61-0.79) for mortality at 90-days, 0.73 (95% CI 0.64-0.80; p < 0.001) for mortality at 1-year. Pre-stroke CHADSVASc score represents a good predictor for short- and long-term outcomes in AIS patients treated with IVT.
CHADS-VASc 评分是评估房颤患者血栓栓塞风险的有效工具。 卒中前 CHADS-VASc 评分可能预测无房颤急性缺血性卒中 (AIS) 患者的结局。本研究旨在探讨卒中前 CHADS-VASc 评分是否能够预测接受静脉溶栓 (IVT) 的 AIS 患者的短期和长期结局。研究组包括 2015 年 1 月至 2017 年 3 月期间在乌迪内大学医院因 AIS 接受 IVT 的 256 例连续患者。根据收集的基线数据计算每位患者的卒中前 CHADS-VASc 评分。根据卒中前 CHADS-VASc 评分将患者分为三组：评分 0-1 分、评分 2-3 分和评分>3 分。主要结局测量指标为：90 天和 1 年时的良好结局率，以及 90 天和 1 年时的死亡率。收集了 165 例患者 (整个样本的 65%)卒中后 1 年的功能结局和死亡率数据。良好结局定义为改良 Rankin 量表评分≤2 分。与 CHADS-VASc 评分 0-1 组相比，评分较高的患者在卒中后 3 个月和 1 年时的结局更差，死亡率更高。AUC-ROC 评估的 CHADS-VASc 评分的诊断性能为：90 天内良好结局的 AUC-ROC 为 0.70(95%CI，0.64-0.76;p<0.001)，1 年时良好结局的 AUC-ROC 为 0.78(95%CI，0.71-0.85;p<0.001)，90 天内死亡率的 AUC-ROC 为 0.71(95%CI 0.61-0.79)，1 年时死亡率的 AUC-ROC 为 0.73(95%CI 0.64-0.80;p<0.001)。卒中前 CHADSVASc 评分是 IVT 治疗 AIS 患者短期和长期结局的良好预测指标。
