Changes in CHA2DS2-VASc score and risk of ischemic stroke among patients with atrial fibrillation,Heart and Vessels

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Changes in CHA2DS2-VASc score and risk of ischemic stroke among patients with atrial fibrillation
Heart and Vessels ( IF 1.4 ) Pub Date : 2023-06-13 , DOI: 10.1007/s00380-023-02278-1
Eirinaios Tsiartas ₁ , Athanasios Samaras ₁ , Andreas S Papazoglou ₁ , Anastasios Kartas ₁ , Dimitrios V Moysidis ₁ , Eleftherios Gemousakakis ₁ , Odysseas Kamzolas ₁ , Alexandra Bekiaridou ₁ , Ioannis Doundoulakis ₁ , Apostolos Tzikas ₁ , George Giannakoulas ₁

Affiliation

Aims

The CHA₂DS₂-VASc score is fundamental to stroke risk assessment in atrial fibrillation. However, stroke-related risk factors can be modified later in life. This study aimed to assess the association of changes in CHA₂DS₂-VASc score over time (Delta CHA₂DS₂-VASc score) with the risk of ischemic stroke.

Materials and methods

This is an observational analysis of 1127 atrial fibrillation patients previously enrolled in the MISOAC-AF trial. After a median 2.6-year follow-up period, baseline and follow-up CHA₂DS₂-VASc scores were used to extract the Delta CHA₂DS₂-VASc score. The stroke predicting accuracies of the baseline, follow-up, and Delta CHA₂DS₂-VASc scores were assessed through regression analyses.

Results

The mean baseline, follow-up, and Delta CHA₂DS₂-VASc scores were 4.2, 4.8, and 0.6 respectively. Ischemic stroke occurred in 54 (4.4%) patients, of which 83.3% had a Delta CHA₂DS₂-VASc score ≥1, contrary to 40.1% of the stroke-free group. The stroke risk per 1-point increase of the CHA₂DS₂-VASc score was not significantly associated with the baseline score (aHR=1.14; 95%CI: 0.93-1.41; p=0.201), whereas a significant association was observed with the follow-up (aHR=2.58; 95% CI: 2.07-3.21; p<0.001) and Delta (aHR=4.56; 95%CI: 3.50-5.94; p<0.001) scores. C-index assessment indicated that follow-up and Delta CHA₂DS₂-VASc scores were more potent predictors of ischemic stroke compared to baseline.

Conclusion

In atrial fibrillation patients, changes in CHA₂DS₂-VASc score over time were associated with the incidence of stroke. The improved predictability of follow-up and Delta CHA₂DS₂-VASc scores indicates that stroke risk is not a static parameter.

Trial registration

This is an observational, post-hoc analysis of the MISOAC-AF randomized controlled trial, registered on ClinicalTrials.gov (identifier: NCT02941978; registered: October 21, 2016).

中文翻译：

房颤患者CHA2DS2-VASc评分变化与缺血性脑卒中风险

目标

CHA ₂ DS ₂ -VASc 评分是心房颤动中风风险评估的基础。然而，中风相关的危险因素可以在以后的生活中改变。本研究旨在评估 CHA ₂ DS ₂ -VASc 评分随时间的变化（Delta CHA ₂ DS ₂ -VASc 评分）与缺血性中风风险的关联。

材料和方法

这是对先前参加 MISOAC-AF 试验的 1127 名房颤患者的观察性分析。中位 2.6 年随访期后，使用基线和随访 CHA ₂ DS ₂ -VASc 评分来提取 Delta CHA ₂ DS ₂ -VASc 评分。通过回归分析评估基线、随访和 Delta CHA ₂ DS ₂ -VASc 评分的卒中预测准确性。

结果

平均基线、随访和Delta CHA ₂ DS ₂ -VASc 评分分别为4.2、4.8 和0.6。54 名（4.4%）患者发生缺血性卒中，其中 83.3% 的 Delta CHA ₂ DS ₂ -VASc 评分≥1，而无卒中组的这一比例为 40.1%。_{CHA 2} DS ₂ -VASc 评分每增加 1 分，卒中风险与基线评分不显着相关（aHR=1.14；95%CI：0.93-1.41；p =0.201），而与基线评分存在显着相关性。随访评分（aHR=2.58；95% CI：2.07-3.21；p <0.001）和 Delta（aHR=4.56；95% CI：3.50-5.94；p <0.001）评分。C 指数评估表明，与基线相比，随访和 Delta CHA ₂ DS _{2 -VASc 评分是缺血性中风更有效的预测因子。}