Impact of CHADS2 score on neurological severity and long-term outcome in atrial fibrillation-related ischemic stroke

Dohoung Kim, Jong Won Chung, Chi Kyung Kim, Wi Sun Ryu, Eun Sun Park, Seung Hoon Lee, Byung Woo Yoon

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background and Purpose The CHADS2 (an acronym for congestive heart failure, hypertension, age ≥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 ≥2, and a modified Rankin Scale (mRS) score of ≥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.

Original languageEnglish
Pages (from-to)251-258
Number of pages8
JournalJournal of Clinical Neurology (Korea)
Volume8
Issue number4
DOIs
Publication statusPublished - 2012 Dec 1
Externally publishedYes

Fingerprint

Atrial Fibrillation
Stroke
Confidence Intervals
National Institutes of Health (U.S.)
Odds Ratio
Thromboembolism
Transient Ischemic Attack
Blood Vessels
Cause of Death
Diabetes Mellitus
Heart Failure
Hypertension
Mortality

Keywords

  • Atrial fibrillation
  • CHADS score
  • Ischemic stroke
  • Neurological severity
  • Outcome

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Impact of CHADS2 score on neurological severity and long-term outcome in atrial fibrillation-related ischemic stroke. / Kim, Dohoung; Chung, Jong Won; Kim, Chi Kyung; Ryu, Wi Sun; Park, Eun Sun; Lee, Seung Hoon; Yoon, Byung Woo.

In: Journal of Clinical Neurology (Korea), Vol. 8, No. 4, 01.12.2012, p. 251-258.

Research output: Contribution to journalArticle

Kim, Dohoung ; Chung, Jong Won ; Kim, Chi Kyung ; Ryu, Wi Sun ; Park, Eun Sun ; Lee, Seung Hoon ; Yoon, Byung Woo. / Impact of CHADS2 score on neurological severity and long-term outcome in atrial fibrillation-related ischemic stroke. In: Journal of Clinical Neurology (Korea). 2012 ; Vol. 8, No. 4. pp. 251-258.
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AU - Lee, Seung Hoon

AU - Yoon, Byung Woo

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AB - Background and Purpose The CHADS2 (an acronym for congestive heart failure, hypertension, age ≥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 ≥2, and a modified Rankin Scale (mRS) score of ≥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.

KW - Atrial fibrillation

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KW - Outcome

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