Abstract 18978: CHA2DS2-VASc Score Predicts the Occurrence of Perioperative Stroke in CABG Patients Without Post-operative Atrial Fibrillation
Introduction: The CHA2DS2-VASc score is a clinical guideline for assessing ischemic stroke risk in patients with atrial fibrillation (AF). However, new evidence suggest that the CHA2DS2-VASc predicts vascular dysfunction and cardiovascular events in high-risk CV patients without clinical AF.
Hypothesis: The CHA2DS2-VASc score predicts the occurrence of perioperative stroke in patients in sinus rhythm submitted to CABG in absence of post-operative AF
Methods: We analyzed 112 consecutive patients in sinus rhythm and without history of AF who were submitted to elective CABG. Clinical and laboratory characteristics were recorded at baseline and 72 h after surgery. All subjects were monitored for 72 hours to exclude postoperative AF. A standardized MRI with stroke protocol was performed in the preoperative period in all subjects and within 5 days after surgery to detect evidence of perioperative stroke.
Results: Patient mean age was 65 ± 15 years, 81.2% male. During follow-up, 26.8% of the patients showed new defects in MRI compatible with ischemic stroke, but only two exhibited overt neurological impairment. Baseline and postoperative inflammatory and coagulation markers, CPB and aortic clamp time as well as standard echocardiographic characteristics were similar in patients with and without perioperative stroke. CHA2DS2-VASc score was higher in patients who developed perioperative stroke (3.13 ± 1.4 vs 2.30 ± 1.2, p=0.01). Figure 1 shows the distribution of stroke cases according to CHA2DS2-VASc score. In a multivariate analysis, CHA2DS2-VASc2 was the only independent predictor of perioperative stroke in this population (HR 1.55, 95% CI 1.104-2.176, p=0.01).
Conclusions: The CHA2DS2-VASc score predicts the occurrence of perioperative stroke in CABG patients without clinical AF. Patients with a score of 3 or more exhibit an increased risk for perioperative stroke even after adjusting for age, smoking and significant comorbidities.
Author Disclosures: H. Verdejo: None. P. Barra: None. R. Zalaquett: None. I. Huete: None. R. Corbalan: None.
- © 2015 by American Heart Association, Inc.