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The relationship between the pre‐admission CHA 2 DS 2 ‐ VAS c score and proximal artery occlusion in patients with acute stroke and atrial fibrillation
Author(s) -
Sakamoto Y.,
Sato S.,
Hama Y.,
Nagatsuka K.,
Minematsu K.,
Toyoda K.
Publication year - 2015
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.12711
Subject(s) - medicine , atrial fibrillation , interquartile range , cardiology , odds ratio , confidence interval , modified rankin scale , stroke (engine) , cha2ds2–vasc score , occlusion , ischemic stroke , ischemia , mechanical engineering , engineering
Background and purpose The CHA 2 DS 2 ‐ VAS c score is associated with severity and outcome of ischaemic stroke in patients with atrial fibrillation ( AF ). It was hypothesized that a high CHA 2 DS 2 ‐ VAS c score was related to severity and outcome because of its association with proximal artery occlusion ( PAO ). This study aimed to elucidate the relationship between the CHA 2 DS 2 ‐ VAS c score and PAO and to determine whether the effect of the CHA 2 DS 2 ‐ VAS c score on severity or outcome is independent of PAO . Methods Acute stroke patients with AF were retrospectively enrolled. PAO was defined as occlusion at the internal carotid artery or proximal middle cerebral artery on admission magnetic resonance angiography. Multivariable analyses were performed to identify independent factors associated with PAO and determine the associations of the CHA 2 DS 2 ‐ VAS c score with the initial National Institutes of Health Stroke Scale ( NIHSS ) score and poor functional outcome (discharge modified Rankin scale score 4–6). Results In all, 213 patients [102 women; median age 80 (interquartile range 71–86) years; NIHSS score 16 (9–22)] were enrolled. On multivariable analysis, the CHA 2 DS 2 ‐ VAS c score (odds ratio 1.40, 95% confidence interval 1.12–1.76 per 1 point) was independently associated with PAO and correlated with the initial NIHSS score (standardized coefficient 0.198, P = 0.017). This association was not significant after further adjustment for PAO (0.080, P = 0.241). The CHA 2 DS 2 ‐ VAS c score was independently related to poor outcome even adjusted for PAO (odds ratio 1.39, 95% confidence interval 1.03–1.88). Conclusion The CHA 2 DS 2 ‐ VAS c score was associated with PAO in acute ischaemic stroke patients with AF . The CHA 2 DS 2 ‐ VAS c score may be correlated with the NIHSS score through the presence of PAO and with poor functional outcome independently of PAO .