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Prestroke CHA2DS2-VASc Score and Severity of Acute Stroke in Patients with Atrial Fibrillation: Findings from RAF Study
M. Acciarresi, M. Paciaroni, G. Agnelli, N. Falocci, V. Caso, C. Becattini, S. Marcheselli, C. Rueckert, A. Pezzini, A. Morotti, P. Costa, A. Padovani, L. Csiba, L. Szabó, SI. Sohn, T. Tassinari, AH. Abdul-Rahim, P. Michel, M. Cordier, P....
Language English Country United States
Document type Journal Article, Multicenter Study
- MeSH
- Time Factors MeSH
- Stroke diagnosis etiology mortality MeSH
- Atrial Fibrillation complications diagnosis mortality MeSH
- Risk Assessment MeSH
- Humans MeSH
- Linear Models MeSH
- Logistic Models MeSH
- Magnetic Resonance Imaging MeSH
- Decision Support Techniques * MeSH
- Multivariate Analysis MeSH
- Odds Ratio MeSH
- Area Under Curve MeSH
- Tomography, X-Ray Computed MeSH
- Disability Evaluation MeSH
- Predictive Value of Tests MeSH
- Prognosis MeSH
- Prospective Studies MeSH
- Risk Factors MeSH
- ROC Curve MeSH
- Chi-Square Distribution MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Severity of Illness Index MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Geographicals
- Asia MeSH
- Europe MeSH
BACKGROUND AND PURPOSE: The aim of this study was to investigate for a possible association between both prestroke CHA2DS2-VASc score and the severity of stroke at presentation, as well as disability and mortality at 90 days, in patients with acute stroke and atrial fibrillation (AF). METHODS: This prospective study enrolled consecutive patients with acute ischemic stroke, AF, and assessment of prestroke CHA2DS2-VASc score. Severity of stroke was assessed on admission using the National Institutes of Health Stroke Scale (NIHSS) score (severe stroke: NIHSS ≥10). Disability and mortality at 90 days were assessed by the modified Rankin Scale (mRS <3 or ≥3). Multiple logistic regression was used to correlate prestroke CHA2DS2-VASc and severity of stroke, as well as disability and mortality at 90 days. RESULTS: Of the 1020 patients included in the analysis, 606 patients had an admission NIHSS score lower and 414 patients higher than 10. At 90 days, 510 patients had mRS ≥3. A linear correlation was found between the prestroke CHA2DS2-VASc score and severity of stroke (P = .001). On multivariate analysis, CHA2DS2-VASc score correlated with severity of stroke (P = .041) and adverse functional outcome (mRS ≥3) (P = .001). A logistic regression with the receiver operating characteristic graph procedure (C-statistics) evidenced an area under the curve of .60 (P = .0001) for severe stroke. Furthermore, a correlation was found between prestroke CHA2DS2-VASc score and lesion size. CONCLUSIONS: In patients with AF, in addition to the risk of stroke, a high CHA2DS2-VASc score was independently associated with both stroke severity at onset and disability and mortality at 90 days.
2nd Department of Neurology Attikon Hospital University of Athens School of Medicine Athens Greece
Abteilung für Neurologie Oberschwabenklinik gGmbH Ravensburg Germany
Clinica Neurologica Azienda Ospedaliero Universitaria Pisa Italy
Department of Internal Medicine Cecina Hospital Cecina Livorno Italy
Department of Internal Medicine Insubria University Varese Italy
Department of Internal Medicine Ospedale Civile di Piacenza Piacenza Italy
Department of Neurology and Psychiatry Sapienza University of Rome Rome Italy
Department of Neurology Born Bunge Institute Antwerp University Hospital Antwerp Belgium
Department of Neurology Dresden University Stroke Center Dresden Germany
Department of Neurology Helsinki University Central Hospital Helsinki Finland
Department of Neurology Keimyung University School of Medicine Daegu South Korea
Department of Neurology University of L'Aquila L'Aquila Italy
International Clinic Research Center St Anne's University Hospital Brno Brno Czech Republic
Neurologia d'urgenza e Stroke Unit Istituto Clinico Humanitas Rozzano Milano Italy
Neurology Hamad Medical Corporation Doha Qatar
SSO Stroke Unit UO Neurologia DAI di Neuroscienze AOUI Verona Italy
Stroke Unit and Division of Internal and Cardiovascular Medicine University of Perugia Perugia Italy
Stroke Unit AOU Senese Siena Italy
Stroke Unit Department of Neurology Sant'Andrea Hospital La Spezia Italy
Stroke Unit Department of Neurology Santa Corona Hospital Pietra Ligure Savona Italy
Stroke Unit Dipartimento Geriatrico Riabilitativo University of Parma Parma Italy
Stroke Unit Jazzolino Hospital Vibo Valentia Italy
Stroke Unit Neurology Insubria University Varese Italy
Stroke Unit Neuroscience Department University of Parma Parma Italy
Stroke Unit Ospedale Civico Palermo Italy
Stroke Unit Ospedale di Portogruaro Portogruaro Venice Italy
Stroke Unit University of Debrecen Debrecen Hungary
UO Gravi Cerebrolesioni San Giovanni Battista Hospital Foligno Italy
References provided by Crossref.org
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- $a Acciarresi, Monica $u Stroke Unit and Division of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy. Electronic address: macun77@hotmail.com.
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- $a Prestroke CHA2DS2-VASc Score and Severity of Acute Stroke in Patients with Atrial Fibrillation: Findings from RAF Study / $c M. Acciarresi, M. Paciaroni, G. Agnelli, N. Falocci, V. Caso, C. Becattini, S. Marcheselli, C. Rueckert, A. Pezzini, A. Morotti, P. Costa, A. Padovani, L. Csiba, L. Szabó, SI. Sohn, T. Tassinari, AH. Abdul-Rahim, P. Michel, M. Cordier, P. Vanacker, S. Remillard, A. Alberti, M. Venti, C. D'Amore, U. Scoditti, L. Denti, G. Orlandi, A. Chiti, G. Gialdini, P. Bovi, M. Carletti, A. Rigatelli, J. Putaala, T. Tatlisumak, L. Masotti, G. Lorenzini, R. Tassi, F. Guideri, G. Martini, G. Tsivgoulis, K. Vadikolias, C. Liantinioti, F. Corea, M. Del Sette, W. Ageno, ML. De Lodovici, G. Bono, A. Baldi, S. D'Anna, S. Sacco, A. Carolei, C. Tiseo, D. Imberti, D. Zabzuni, B. Doronin, V. Volodina, D. Consoli, F. Galati, A. Pieroni, D. Toni, S. Monaco, MM. Baronello, K. Barlinn, LP. Pallesen, J. Kepplinger, U. Bodechtel, J. Gerber, D. Deleu, G. Melikyan, F. Ibrahim, N. Akhtar, MG. Mosconi, KR. Lees,
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- $a BACKGROUND AND PURPOSE: The aim of this study was to investigate for a possible association between both prestroke CHA2DS2-VASc score and the severity of stroke at presentation, as well as disability and mortality at 90 days, in patients with acute stroke and atrial fibrillation (AF). METHODS: This prospective study enrolled consecutive patients with acute ischemic stroke, AF, and assessment of prestroke CHA2DS2-VASc score. Severity of stroke was assessed on admission using the National Institutes of Health Stroke Scale (NIHSS) score (severe stroke: NIHSS ≥10). Disability and mortality at 90 days were assessed by the modified Rankin Scale (mRS <3 or ≥3). Multiple logistic regression was used to correlate prestroke CHA2DS2-VASc and severity of stroke, as well as disability and mortality at 90 days. RESULTS: Of the 1020 patients included in the analysis, 606 patients had an admission NIHSS score lower and 414 patients higher than 10. At 90 days, 510 patients had mRS ≥3. A linear correlation was found between the prestroke CHA2DS2-VASc score and severity of stroke (P = .001). On multivariate analysis, CHA2DS2-VASc score correlated with severity of stroke (P = .041) and adverse functional outcome (mRS ≥3) (P = .001). A logistic regression with the receiver operating characteristic graph procedure (C-statistics) evidenced an area under the curve of .60 (P = .0001) for severe stroke. Furthermore, a correlation was found between prestroke CHA2DS2-VASc score and lesion size. CONCLUSIONS: In patients with AF, in addition to the risk of stroke, a high CHA2DS2-VASc score was independently associated with both stroke severity at onset and disability and mortality at 90 days.
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