CHA2DS2-VASc scores for outcome prediction in acute ischaemic stroke

Background: The CHADS2 and CHA2DS2-VASc scores are clinical risk stratification instruments that are used clinically to assess the risk of stroke in patients with atrial fibrillation (AF). The aim of this study was to evaluate whether the prestroke CHADS2 and CHA2DS2-VASc scores could be useful for predicting infarction severity and long-term outcomes in patients with acute ischaemic stroke. Materials and methods: This prospective study included all 1494 patients who had acute ischaemic stroke without haemorrhagic transformation which was evidenced with magnetic resonance (MR) imaging during hospitalization. Total infarction volume and arterial stenosis score were calculated based on MR imaging. National Institutes of Health Stroke Scale scores (NIHSSs) were obtained at admission and discharge by board-certified neurologists. The clinical outcomes were defined as composite endpoints of restroke and mortality and were recorded with the mean follow-up period of 37.5 months. Results: There were 195 (13.1%) patients with AF. The patients with AF had significantly higher median CHADS2 and CHA2DS2-VASc scores than the patients without AF (P <.001). Patients with higher CHADS2 and CHA2DS2-VASc scores had significantly higher total infarction volume, arterial stenosis score and NIHSS scores at discharge and poorer clinical outcomes. After adjusting for age, gender and AF, only CHA2DS2-VASc scores could predict both restroke and composite endpoints. Conclusions: Prestroke CHA2DS2-VASc scores appear to have better clinical value for predicting the severity of infarction and long-term clinical outcomes in acute ischaemic stroke patients with and without AF.