Related Experiment Video
Updated: Jul 9, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
CHA2DS2-VASc Score as a Predictor of Adverse Outcomes after Ischemic Stroke in Patients without Atrial Fibrillation
Amir Aker1, Ina Volis2, Walid Saliba3
1Department of Cardiology, Carmel Medical Center, Haifa, Israel.
Insights
The CHA2DS2-VASc score can help predict major adverse cardiac and cerebrovascular events (MACCE) in middle-aged patients who have had an ischemic stroke but no atrial fibrillation (AF). Higher scores indicate a greater risk of future vascular events.
Area of Science:
- Cardiology
- Neurology
- Vascular Medicine
Background:
- Ischemic stroke increases the risk of subsequent vascular events, impacting morbidity and mortality.
- Risk stratification is crucial for managing patients post-stroke.
- Atrial fibrillation (AF) is a known risk factor, but risk assessment in non-AF patients is less clear.
Purpose of the Study:
- To evaluate the utility of the CHA2DS2-VASc score for risk stratification.
- To assess the score's ability to predict major adverse cardiac and cerebrovascular events (MACCE) in middle-aged ischemic stroke patients without AF.
Main Methods:
- Analysis of 2628 patients aged 40-65 with acute ischemic stroke and no known AF.
- Exploration of CHA2DS2-VASc scores (2-3, 4-5, 6-7) and their association with MACCE.
- Median follow-up of 19.9 months, including recurrent stroke, myocardial infarction, revascularization, and all-cause death.
Main Results:
- Higher CHA2DS2-VASc scores correlated with increased MACCE incidence (6.7, 12.2, 21.2 per 100 person-years for scores 2-3, 4-5, 6-7).
- Adjusted hazard ratios for MACCE were 1.74 (score 4-5) and 2.87 (score 6-7) compared to score 2-3.
- The score showed modest discriminative capacity for overall MACCE (AUC 0.63) but was better for myocardial infarction (AUC 0.69).
Conclusions:
- The CHA2DS2-VASc score demonstrates potential for predicting future MACCE in middle-aged ischemic stroke patients without AF.
- This score may aid in identifying high-risk individuals for targeted preventive strategies.
- Further research could refine its application in this specific patient population.
Background:
Ischemic stroke is associated with increased risk of morbidity and mortality in future vascular events.
Objectives:
To investigate whether CHA2DS2-VASc scores aid in risk stratification of middle-aged patients without atrial fibrillation (AF) experiencing ischemic stroke.
Methods:
We analyzed data of 2628 patients, aged 40-65 years with no known AF who presented with acute ischemic stroke between January 2020 and February 2022. We explored the association between CHA2DS2-VASc scores categorized by subgroups (score 2-3, 4-5, or 6-7) with major adverse cardiac and cerebrovascular events (MACCE) including recurrent stroke, myocardial infarction, coronary revascularization, or all-cause death during a median follow-up of 19.9 months.
Results:
Mean age was 57 years (30% women); half were defined as low socioeconomic status. Co-morbidities included hypertension, diabetes, obesity, and smoking in 40-60% of the patients. The incidence rate of MACCE per 100 person-years was 6.7, 12.2, and 21.2 in those with score 2-3, 4-5, and 6-7, respectively. In a multivariate cox regression model, compared to patients with score 2-3 (reference group), those with score 4-5 and 6-7 had an adjusted hazard ratio (95% confidence interval [95%CI]) for MACCE of 1.74 (95%CI 1.41-2.14) and 2.87 (95%CI 2.10-3.93), respectively. The discriminative capacity of CHA2DS2-VASc score for overall MACCE was modest (area under curve 0.63; 95%CI 0.60-0.66), although better for myocardial infarction 0.69 (95% CI 0.61-0.77).
Conclusions:
CHA2DS2-VASc score may predict future MACCE in middle-aged patients with ischemic stroke and no history of AF.
More Related Videos
Related Concept Videos
01:22Cardiac Output II: Effect of Stroke Volume on Cardiac Output
Preload
Preload refers to the initial elongation of the cardiac myocytes before contraction and is related to the volume of blood filling the heart at the end of diastole, or end-diastolic volume. The...
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:27Atherosclerosis II: Clinical Manifestations and Diagnostic Tests
01:21Aneurysm II: Clinical Manifestations and Diagnostic Studies