Predicting stroke in patients without atrial fibrillation.

Area of Science:

• Cardiology
• Vascular Medicine
• Clinical Risk Stratification

Background:

• Limited research exists on the predictive value of the CHA2DS2-VASc score for atrial fibrillation and thromboembolic events in patients without diagnosed atrial fibrillation.
• The CHA2DS2-VASc score is widely used for stroke risk assessment in patients with atrial fibrillation.

Purpose of the Study:

• To evaluate the CHA2DS2-VASc score's ability to predict incident atrial fibrillation and thromboembolic events in patients without pre-existing atrial fibrillation.
• To assess the risk stratification capabilities of the CHA2DS2-VASc score in a large cohort undergoing coronary angiography.

Main Methods:

• A retrospective cohort study included 78,233 patients who underwent coronary angiography between 2004 and 2012.
• Patients with atrial fibrillation, on anticoagulant therapy, or with less than 30 days of follow-up were excluded.
• Endpoints included new-onset atrial fibrillation and a composite of ischemic stroke, transient ischemic attack, and systemic embolism. Event rates were analyzed across CHA2DS2-VASc scores (0, 1, 2, 3, 4, >4).

Main Results:

• An increasing CHA2DS2-VASc score was significantly associated with a higher incidence of atrial fibrillation (P < 0.0001).
• Higher CHA2DS2-VASc scores also correlated with an increased risk of ischemic stroke, transient ischemic attack, systemic embolism, and all-cause death (P < 0.0001).
• Patients with a CHA2DS2-VASc score of 3 experienced a 1.30 per 100 person-years rate of ischemic stroke/transient ischemic attack/systemic embolism.

Conclusions:

• The CHA2DS2-VASc score is a valuable tool for predicting future atrial fibrillation and thromboembolic events in patients without atrial fibrillation undergoing coronary angiography.
• A CHA2DS2-VASc score of 3 identified patients at a risk level comparable to that of patients with atrial fibrillation who typically receive prophylactic anticoagulation.