Predictive value of CHA2DS2-VASc score for long-term outcomes after large vessel occlusion in patients with non-valvular atrial fibrillation.

BACKGROUND

The CHA2DS2-VASc score assesses the stroke risk in patients with atrial fibrillation (AF). This study determined the predictive value of the CHA2DS2-VASc score for long-term outcomes after acute ischemic stroke (AIS) with large vessel occlusion (LVO) in patients with AF.

METHODS

Patients with AF who were started on oral anticoagulant apixaban within 14 days of the onset of AIS due to LVO from a multicenter prospective observational study were included. They were divided into three groups based on the pre-stroke CHA2DS2-VASc score (0-1, 2-3, and ≥ 4) and were compared for poor outcomes (modified Rankin Scale 3-6) at 90 and 365 days, ischemic events, major bleeding events, death from any cause, and the composite of these outcomes within 365 days of apixaban administration.

RESULTS

The analysis included 632 patients (mean age 77.4 years, 48.1% female; median CHA2DS2-VASc score, 3). Higher CHA2DS2-VASc scores were associated with worse one-year outcome (p for trend<0.0001) and higher composite endpoint incidence (p for trend = 0.003). The multivariable analysis showed that compared with patients with CHA2DS2-VASc scores of 0-1, those with CHA2DS2-VASc scores of 2-3 and ≥ 4 had odds ratios 2.4 (95% confidence interval [CI] 1.31-4.47, p = 0.005) and 3.4 (95% CI 1.71-6.81, p < 0.001), respectively, for one-year outcomes and hazard ratios of 1.7 (95% CI 0.80-3.43, p = 0.178) and 2.1 (95% CI 0.98-4.68, p = 0.055), respectively, for composite endpoints.

CONCLUSION

The CHA2DS2-VASc score is useful in predicting long-term functional outcomes after LVO in patients with AF.