Association of the CHAD(S)-VASc Score and Its Components With Overt and Silent Ischemic Brain Lesions in Patients With Atrial Fibrillation.

Silent and overt ischemic brain lesions are common and associated with adverse outcome. Whether the CHADS-VASc score and its components predict magnetic resonance imaging (MRI)-detected ischemic silent and overt brain lesions in patients with atrial fibrillation (AF) is unclear. In this cross-sectional analysis, patients with AF were enrolled in a multicenter cohort study in Switzerland. Outcomes were clinically overt, silent [in the absence of a history of stroke/transient ischemic attack (TIA)] and any MRI-detected ischemic brain lesions. Logistic regression analyses were performed to assess the relationship of the CHADS-VASc score and its components with ischemic brain lesions. An adapted CHAD-VASc score (excluding history of stroke/TIA) for the analyses of clinically overt and silent ischemic brain lesions was used. Overall, 1,741 patients were included in the analysis (age 73 ± 8 years, 27.4% female). At least one ischemic brain lesion was observed in 36.8% (clinically overt: 10.5%; silent: 22.9%; transient ischemic attack: 3.4%). The CHAD-VASc score was strongly associated with clinically overt and silent ischemic brain lesions {odds ratio (OR) [95% confidence interval (CI)] 1.32 (1.17-1.49), < 0.001 and 1.20 (1.10-1.30), < 0.001, respectively}. Age 65-74 years (OR 2.58; 95%CI 1.29-5.90; = 0.013), age ≥75 years (4.13; 2.07-9.43; < 0.001), hypertension (1.90; 1.28-2.88; = 0.002) and diabetes (1.48; 1.00-2.18; = 0.047) were associated with clinically overt brain lesions, whereas age 65-74 years (1.95; 1.26-3.10; = 0.004), age ≥75 years (3.06; 1.98-4.89; < 0.001) and vascular disease (1.39; 1.07-1.79; = 0.012) were associated with silent ischemic brain lesions. A higher CHAD-VASc score was associated with a higher risk of both overt and silent ischemic brain lesions. www.ClinicalTrials.gov, identifier: NCT02105844.