J Clin Neurol.  2012 Dec;8(4):251-258. 10.3988/jcn.2012.8.4.251.

Impact of CHADS2 Score on Neurological Severity and Long-Term Outcome in Atrial Fibrillation-Related Ischemic Stroke

• Kim D
• Chung JW
• Kim CK
• Ryu WS
• Park ES
• Lee SH
• Yoon BW

• KMID: 2287575
• DOI: http://doi.org/10.3988/jcn.2012.8.4.251

Abstract

BACKGROUND AND PURPOSE
The CHADS2 (an acronym for congestive heart failure, hypertension, age > or =75 years, diabetes mellitus, and prior stroke or transient ischemic attack or thromboembolism) score is a widely used system for estimating the risk of stroke in patients with atrial fibrillation. However, how the CHADS2 score is related to stroke severity and outcome in patients with strokes due to atrial fibrillation has not yet been elucidated.
METHODS
We enrolled patients with atrial fibrillation who visited our stroke center within 7 days after the onset of acute ischemic stroke between October 2002 and September 2008. CHADS2 scores were categorized into three groups: 0 points, low risk; 1 or 2 points, intermediate risk; and 3-6 points, high risk. Poor neurological state was defined as follows: a National Institutes of Health Stroke Scale (NIHSS) score of > or =2, and a modified Rankin Scale (mRS) score of > or =3 at discharge. Mortality information was ascertained as at December 2008.
RESULTS
A cohort of 298 patients with atrial-fibrillation-related stroke was included in this study. A high-risk CHADS2 score at admission was a powerful predictor of poor neurological outcome [for NIHSS: odds ratio (OR), 4.17; 95% confidence interval (CI), 1.76-9.87; for mRS: OR, 2.97; 95% CI, 1.23-7.16] after controlling for all possible confounders. In addition, a high-risk CHADS2 score was an independent predictor of all causes of death during the follow-up [hazard ratio (HR), 3.01; 95% CI, 1.18-7.65] and vascular death (HR, 12.25; 95% CI, 1.50-99.90).
CONCLUSIONS
Although the CHADS2 score was originally designed to distinguish patients with a future risk of stroke, our study shows that it may also be used to predict poor neurological outcome after atrial-fibrillation-related stroke.

Keyword

atrial fibrillation; ischemic stroke; CHADS2 score; neurological severity; outcome

MeSH Terms

Atrial Fibrillation
Cause of Death
Cohort Studies
Diabetes Mellitus
Follow-Up Studies
Heart Failure
Humans
Hypertension
Ischemic Attack, Transient
National Institutes of Health (U.S.)
Odds Ratio
Stroke

Figure

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  Fig. 1 Kaplan-Meier curves of all-cause (A), vascular (B), and nonvascular (C) deaths.

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