Prestroke CHA 2 DS 2 -VASc Score and Severity of Acute Stroke in Patients with Atrial Fibrillation: Findings from RAF Study.

Background and Purpose: The aim of this study was to investigate for a possible association between both prestroke CHA ₂ DS ₂ -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 CHA ₂ DS ₂ -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 CHA ₂ DS ₂ -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 CHA ₂ DS ₂ -VASc score and severity of stroke (P = .001). On multivariate analysis, CHA ₂ DS ₂ -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 CHA ₂ DS ₂ -VASc score and lesion size.
Conclusions: In patients with AF, in addition to the risk of stroke, a high CHA ₂ DS ₂ -VASc score was independently associated with both stroke severity at onset and disability and mortality at 90 days.
(Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.)