Abstract 16287: The Efficacy of CHA2DS2-VASc Score to Predict Ischemic Stroke in Patients With Atrial Fibrillation in Clinical Practice: 4-Year Follow-Up Study -A Report From the STACIN Registry-
Background: Risk stratification of ischemic stroke is essential in patients with atrial fibrillation. CHADS2 score and CHA2DS2-VASc score are widely used in patients with atrial fibrillation to evaluate the risk stratification of ischemic stroke. It is still unclear whether CHA2DS2-VASc score is superior to predict ischemic stroke in clinical practice, compared with CHADS2 score.
Methods: In STACIN registry that was multicenter atrial fibrillation registry, 618 patients (mean age: 71±10 years, 431 males) were analyzed.
Results: Distribution of CHADS2 score at baseline was as follows: 102 patients (16.5%) with a CHADS2 score=0, 163 patients (26.4%) with a CHADS2 score=1, 176 patients (28.5%) with a CHADS2 score =2, 97 patients (15.7%) with a CHADS2 score =3, 55 patients (8.9%) with a CHADS2 score =4 and 25 patients (4.1%) with a CHADS2 score≥5. Distribution of CHA2DS2-VASc score at baseline was as follows: 34 patients (5.5%) with a CHA2DS2-VASc score =0, 90 patients (14.6%) with a CHA2DS2-VASc score =1, 138 patients (22.3%) with a CHA2DS2-VASc score =2, and 139 patients (22.5%) with a CHA2DS2-VASc score =3, 62 patients (10.0%) with a CHA2DS2-VASc score =4, 98 patients (15.9%) with a CHA2DS2-VASc score≥5. 494 patients (79.9%) were taking anticoagulant agents. During 4-year follow-up, ischemic stroke was observed in 22 patients (3.6%). CHADS2 score and CHA2DS2-VASc score at baseline were higher in patients with ischemic stroke than those without (2.5±1.3 vs. 1.8±1.3; p=0.02, 3.6±1.4 vs. 2.9±1.6; p=0.03, respectively). Based on receiver-operating characteristics (ROC) analysis, CHADS2 score and CHA2DS2-VASc score achieved the area under the curve (AUC) of 0.65 and 0.64 for the ability to predict ischemic stroke, respectively. Ischemic stroke was observed in 4 patients (1.5%) with a CHADS2 score = 0 or 1, however, no stroke event was observed in patients with a CHA2DS2-VASc score = 0.
Conclusions: During 4-year follow-up, compared with CHADS2 score, CHA2DS2-VASc score was not superior to predict ischemic stroke in patients with atrial fibrillation. However, patients with a CHA2DS2-VASc score=0 may be true low risk group of ischemic stroke, though those with a CHADS2 score =0 or 1 may not be necessarily low risk group in clinical practice.
- © 2013 by American Heart Association, Inc.