Pre-admission CHA2DS2-VASc Score and Outcome of Patients with Acute Cerebrovascular Events - The 64th Annual Conference of the Israel Heart Society & The Israel Society of Cardiothoracic Surgery, 25-26 April 2017

Guy Topaz ¹ David Pereg ² Stefan Mausbach ³ Itzhak Kimiagar ⁴ Gregory Telman ⁵ Yona Kitay-Cohen ¹ Dina Vorobeichik ⁶ Nir Shlomo ⁶ David Tanne ³

¹Department of Internal Medicine C, Meir Medical Center
²Department of Cardiology, Meir Medical Center
³Sagol Neuroscience Center, Chaim Sheba Medical Center
⁴Department of Neurology, Asaf Harofeh Medical Center
⁵Department of Neurology, Rambam Health Care Campus
⁶Israeli Association for Cardiovascular Trials, Sheba Medical Center

Background:
The CHA2DS2-VASc score has been recommended for the assessment of thromboembolic risk in patients with atrial fibrillation. Data regarding the association between the pre-admission CHA2DS2-VASc score and the outcome of patients with stroke and TIA are scarce. We aimed to assess the predictive value of pre-admission CHA2DS2-VASc score for early risk stratification of patients with acute cerebrovascular event.

Methods:
The study group consisted of 8309 patients (53% males, mean age of 70±13.3 years) with acute stroke and TIA included in the prospective National Acute Stroke Israeli (NASIS) registry. The two primary end-points were in-hospital mortality and the composite endpoint of in-hospital mortality or severe disability at discharge. We divided the study population into 4 groups according to their pre-admission CHA2DS2-VASc score (0-1, 2-3, 4-5, >5).

Results:
Following a multivariate analysis odds ratios for all-cause mortality increased for CHA2DS2-VASc score >1 (OR=2.1 95% CI=1.2-3.8, OR=1.8 95% CI=1.1-3.2, OR=1.8 95% CI 1.1-3.3, for patients with CHA2DS2-VASc score of 2-3, 4-5 and >5, respectively, p<0.001). Odds ratios for the composite endpoint of in-hospital mortality or severe disability (mRS>3) at discharge increased significantly in direct association with the CHA2DS2-VASc score (OR=2 95% CI=1.5-2.6, OR=3.3 95%CI=2.5-4.3, OR=5.1 95%CI 3.8-7.0, for CHA2DS2-VASc score patients of 2-3, 4-5 and >5, respectively as compared with 0-1, p<0.001). Each 1-point increase in the CHA2DS2-VASc score was associated with a 31% increase in the risk for the composite end-point.

Conclusions:
High-risk pre-admission CHA2DS2-VASc score among patients with acute cerebrovascular events is associated with higher in-hospital mortality and severe disability at discharge.