CHA₂DS₂-VASc Score Is Associated With Prognosis in Patients With Acute Ischemic Stroke Without Atrial Fibrillation.

IF 0.9 4区医学

Texas Heart Institute Journal Pub Date : 2025-02-04 eCollection Date: 2025-01-01 DOI:10.14503/THIJ-24-8450

Mingjuan Song, Xu Chen

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引用次数: 0

Abstract

Background: Although the prognostic value of the CHA₂DS₂-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack, vascular disease, age 65-74 years, and female sex) scoring system in patients with stroke has been explored in several studies, a research gap exists in its application, especially in patients without atrial fibrillation (AF).

Methods: This study investigated the association between CHA₂DS₂-VASc score and prognosis at 1 year in patients with acute ischemic stroke (AIS) who do not have AF. A total of 993 patients with AIS but without AF were recruited between January 2019 and December 2022. Patients were categorized into high-risk (CHA₂DS₂-VASc score, >2; n = 424), moderate-risk (CHA₂DS₂-VASc score, 2; n = 218), and low-risk (CHA₂DS₂-VASc score, 0-1; n = 351) groups. The primary outcome was major adverse cardiac events (MACE) at 1 year after index AIS. Multivariate Cox regression analyses evaluated the prognostic value of CHA₂DS₂-VASc scores after controlling for potential confounding factors. A sensitivity analysis was performed based on 3 CHA₂DS₂-VASc groups generated using propensity score matching.

Results: The rate of MACE during 12-month follow-up was statistically significantly higher (P < .01) in patients with a CHA₂DS₂-VASc score greater than 2 (34.7%) than in patients with a score of 2 (23.9%) or of 0 or 1 (14.8%). Multivariate Cox regression models indicated that, compared with a CHA₂DS₂-VASc score of 0 or 1, the hazard ratio (HR) of MACE occurrence was 3.22 (95% CI, 1.93-5.37; P < .01) for a CHA₂DS₂-VASc score greater than 2 and 1.92 (95% CI, 1.24-2.98; P < .01) for a CHA₂DS₂-VASc score of 2. When included in the Cox regression model as a continuous variable, the CHA₂DS₂-VASc score remained strongly associated with higher risks of MACE (HR, 1.19 [95% CI, 1.11-1.26]; P < .01), all-cause mortality (HR, 1.14 [95% CI, 1.05-1.23]; P < .01), and recurrent stroke (HR, 1.15 [95% CI, 1.06-1.256]; P < .01). Sensitivity analyses based on populations generated by propensity score matching yielded similar results.

Conclusion: The CHA₂DS₂-VASc score effectively predicts MACE in patients with AIS but without AF, providing more accurate risk stratification.

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急性缺血性卒中无房颤患者CHA2DS2-VASc评分与预后相关

背景：虽然已有多项研究探讨了CHA2DS2-VASc（充血性心力衰竭、高血压、年龄≥75岁、糖尿病、既往脑卒中或短暂性脑缺血发作、血管疾病、年龄65-74岁、女性）评分系统在脑卒中患者中的预后价值，但在其应用方面存在研究空白，特别是在无房颤（AF）患者中的应用。方法：本研究调查无房颤的急性缺血性卒中（AIS）患者1年时CHA2DS2-VASc评分与预后的关系。2019年1月至2022年12月共招募993例AIS但无房颤患者。患者分为高危组(CHA2DS2-VASc评分，bbbb2；n = 424)、中度风险(CHA2DS2-VASc评分，2分；n = 218)，低危(CHA2DS2-VASc评分0-1；N = 351)组。主要终点是AIS指数后1年的主要不良心脏事件（MACE）。在控制了潜在的混杂因素后，多因素Cox回归分析评估CHA2DS2-VASc评分的预后价值。根据倾向评分匹配生成的3个CHA2DS2-VASc组进行敏感性分析。结果：随访12个月期间，CHA2DS2-VASc评分大于2的患者MACE发生率（34.7%）高于评分为2的患者（23.9%）、评分为0或1的患者（14.8%），差异有统计学意义（P < 0.01）。多因素Cox回归模型显示，与CHA2DS2-VASc评分为0或1相比，MACE发生的风险比（HR）为3.22 (95% CI, 1.93 ~ 5.37；P < 0.01)， CHA2DS2-VASc评分大于2和1.92 (95% CI, 1.24-2.98；P < 0.01)， CHA2DS2-VASc评分为2分。当作为连续变量纳入Cox回归模型时，CHA2DS2-VASc评分仍与MACE高风险密切相关(HR, 1.19 [95% CI, 1.11-1.26]；P < 0.01)，全因死亡率(HR, 1.14 [95% CI, 1.05-1.23]；P < 0.01)，卒中复发(HR, 1.15 [95% CI, 1.06-1.256]；P < 0.01)。基于倾向评分匹配生成的群体的敏感性分析也得出了类似的结果。结论：CHA2DS2-VASc评分可有效预测AIS无房颤患者的MACE，提供更准确的风险分层。

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来源期刊

Texas Heart Institute Journal CARDIAC & CARDIOVASCULAR SYSTEMS-

自引率

11.10%

发文量

131

期刊介绍： For more than 45 years, the Texas Heart Institute Journal has been published by the Texas Heart Institute as part of its medical education program. Our bimonthly peer-reviewed journal enjoys a global audience of physicians, scientists, and healthcare professionals who are contributing to the prevention, diagnosis, and treatment of cardiovascular disease. The Journal was printed under the name of Cardiovascular Diseases from 1974 through 1981 (ISSN 0093-3546). The name was changed to Texas Heart Institute Journal in 1982 and was printed through 2013 (ISSN 0730-2347). In 2014, the Journal moved to online-only publication. It is indexed by Index Medicus/MEDLINE and by other indexing and abstracting services worldwide. Our full archive is available at PubMed Central. The Journal invites authors to submit these article types for review: -Clinical Investigations- Laboratory Investigations- Reviews- Techniques- Coronary Anomalies- History of Medicine- Case Reports/Case Series (Submission Fee: $70.00 USD)- Images in Cardiovascular Medicine (Submission Fee: $35.00 USD)- Guest Editorials- Peabody’s Corner- Letters to the Editor