Monica Acciarresi1, Maurizio Paciaroni2, Giancarlo Agnelli2, Nicola Falocci2, Valeria Caso2, Cecilia Becattini2, Simona Marcheselli3, Christina Rueckert4, Alessandro Pezzini5, Andrea Morotti5, Paolo Costa5, Alessandro Padovani5, Laszló Csiba6, Lilla Szabó6, Sung-Il Sohn7, Tiziana Tassinari8, Azmil H Abdul-Rahim9, Patrik Michel10, Maria Cordier10, Peter Vanacker11, Suzette Remillard10, Andrea Alberti2, Michele Venti2, Cataldo D'Amore2, Umberto Scoditti12, Licia Denti13, Giovanni Orlandi14, Alberto Chiti14, Gino Gialdini14, Paolo Bovi15, Monica Carletti15, Alberto Rigatelli15, Jukka Putaala16, Turgut Tatlisumak17, Luca Masotti18, Gianni Lorenzini18, Rossana Tassi19, Francesca Guideri19, Giuseppe Martini19, Georgios Tsivgoulis20, Kostantinos Vadikolias21, Chrissoula Liantinioti22, Francesco Corea23, Massimo Del Sette24, Walter Ageno25, Maria Luisa De Lodovici26, Giorgio Bono26, Antonio Baldi27, Sebastiano D'Anna27, Simona Sacco28, Antonio Carolei28, Cindy Tiseo28, Davide Imberti29, Dorjan Zabzuni29, Boris Doronin30, Vera Volodina30, Domenico Consoli31, Franco Galati31, Alessio Pieroni32, Danilo Toni32, Serena Monaco33, Mario Maimone Baronello33, Kristian Barlinn34, Lars-Peder Pallesen34, Jessica Kepplinger34, Ulf Bodechtel34, Johannes Gerber34, Dirk Deleu35, Gayane Melikyan35, Faisal Ibrahim35, Naveed Akhtar35, Maria Giulia Mosconi2, Kennedy R Lees9. 1. Stroke Unit and Division of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy. Electronic address: macun77@hotmail.com. 2. Stroke Unit and Division of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy. 3. Neurologia d'urgenza e Stroke Unit, Istituto Clinico Humanitas, Rozzano, Milano, Italy. 4. Abteilung für Neurologie, Oberschwabenklinik gGmbH, Ravensburg, Germany. 5. Department of Clinical and Experimental Sciences, Neurology Unit, University "Health and Wealth" of Brescia, Brescia, Italy. 6. Stroke Unit, University of Debrecen, Debrecen, Hungary. 7. Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea. 8. Stroke Unit-Department of Neurology, Santa Corona Hospital, Pietra Ligure, Savona, Italy. 9. Medical School and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom. 10. Centre Cérébrovasculaire, Service de Neurologie, Département des Neurosciences Cliniques Centre Hopitalier Universitaire Vaudois, Lausanne, Switzerland. 11. Department of Neurology, Born Bunge Institute, Antwerp University Hospital, Antwerp, Belgium. 12. Stroke Unit, Neuroscience Department, University of Parma, Parma, Italy. 13. Stroke Unit, Dipartimento Geriatrico Riabilitativo, University of Parma, Parma, Italy. 14. Clinica Neurologica, Azienda Ospedaliero-Universitaria, Pisa, Italy. 15. SSO Stroke Unit, UO Neurologia, DAI di Neuroscienze, AOUI Verona, Italy. 16. Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland. 17. Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland; Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden. 18. Department of Internal Medicine, Cecina Hospital, Cecina, Livorno, Italy. 19. Stroke Unit, AOU Senese, Siena, Italy. 20. Department of Neurology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece; International Clinic Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic; Second Department of Neurology, "Attikon" Hospital, University of Athens, School of Medicine, Athens, Greece. 21. Department of Neurology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece. 22. Second Department of Neurology, "Attikon" Hospital, University of Athens, School of Medicine, Athens, Greece. 23. UO Gravi Cerebrolesioni, San Giovanni Battista Hospital, Foligno, Italy. 24. Stroke Unit, Department of Neurology, Sant'Andrea Hospital, La Spezia, Italy. 25. Department of Internal Medicine, Insubria University, Varese, Italy. 26. Stroke Unit, Neurology, Insubria University, Varese, Italy. 27. Stroke Unit, Ospedale di Portogruaro, Portogruaro, Venice, Italy. 28. Department of Neurology, University of L'Aquila, L'Aquila, Italy. 29. Department of Internal Medicine, Ospedale Civile di Piacenza, Piacenza, Italy. 30. Municipal Budgetary Healthcare Institution of Novosibirsk, City Clinical Hospital #1, Novosibirsk, Russia. 31. Stroke Unit, Jazzolino Hospital, Vibo Valentia, Italy. 32. Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy. 33. Stroke Unit, Ospedale Civico, Palermo, Italy. 34. Department of Neurology, Dresden University Stroke Center, Dresden, Germany. 35. Neurology, Hamad Medical Corporation, Doha, Qatar.
Abstract
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.
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.