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Using the CHA2DS2-VASc score for refining stroke risk stratification in 'low-risk' Asian patients with atrial

Tze-Fan Chao1, Chia-Jen Liu2, Kang-Ling Wang1

  • 1Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.

Journal of the American College of Cardiology
|October 18, 2014
PubMed

Insights

The CHA2DS2-VASc score is superior to the ATRIA score for predicting ischemic stroke in atrial fibrillation patients. ATRIA misclassifies many patients as low-risk, while CHA2DS2-VASc accurately identifies truly low-risk individuals.

Area of Science:

  • Cardiology
  • Neurology
  • Public Health

Background:

  • Atrial fibrillation (AF) necessitates risk stratification for ischemic stroke.
  • The Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) score is a proposed system for AF risk assessment.
  • The ability of the ATRIA score to identify low-risk AF patients for stroke remains uncertain.

Purpose of the Study:

  • To compare the predictive performance of the ATRIA score against the CHA2DS2-VASc score for ischemic stroke in AF patients.
  • To evaluate the accuracy of both scoring systems in identifying low-risk individuals.

Main Methods:

  • Utilized the National Health Insurance research database in Taiwan.
  • Included 186,570 AF patients not receiving antithrombotic therapy.
  • Assessed ischemic stroke as the primary clinical endpoint over a mean follow-up of 3.4 years.

Main Results:

  • CHA2DS2-VASc demonstrated superior predictive accuracy over ATRIA (c-index 0.698 vs. 0.627, p < 0.0001).
  • CHA2DS2-VASc significantly improved risk reclassification by 11.7% compared to ATRIA (p < 0.0001).
  • Among patients with ATRIA score 0-5, CHA2DS2-VASc identified a wide range of stroke risks, with significantly better discrimination (c-index 0.629 vs. 0.593, p < 0.0001).

Conclusions:

  • The ATRIA score inadequately identifies low-risk AF patients, with annual stroke rates up to 2.95% at 1 year.
  • AF patients with a CHA2DS2-VASc score of 0 represent a truly low-risk group, with an approximate 1% annual stroke rate.
  • CHA2DS2-VASc is a more reliable tool for stroke risk stratification in AF patients compared to ATRIA.
Abstract

Keywords:
ATRIA scoreCHA(2)DS(2)-VASc scoreatrial fibrillationischemic stroke

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