Prediction of ischemic stroke by the CHA2DS2-VA score in an Asian population: A report from the prospective nationwide COOL-AF registry.

BACKGROUND

The CHA2DS2-VA score, derived by the removal of women from the CHA2DS2-VASc score, has recently been recommended for the prediction of ischemic stroke/systemic embolism (SSE) in patients with atrial fibrillation (AF).

OBJECTIVE

Given the limited data in non-Western cohorts, the objective was to compare the performance of CHA2DS2-VASc and CHA2DS2-VA scores for the prediction of SSE in an Asian population.

METHODS

Patients with AF from the prospective multicenter Cohort of Antithrombotic Use and Optimal INR Level in Patients With Nonvalvular Atrial Fibrillation registry were studied. Patients were followed up every 6 months for 3 years. The primary outcome was SSE. C-statistics were used to compare the performance of CHA2DS2-VASc and CHA2DS2-VA scores for SSE risk prediction. The pattern of oral anticoagulant use is according to the practicing physicians.

RESULTS

A total of 3405 patients were studied (mean age 67.8 ± 11.3 years, 41.8% women). The incidence rate of SSE was 1.51 (1.26-1.78) per 100 person-years. The risk ratio for SSE for women was higher than men at CHA2DS2-VA scores ≥ 2 (1.72 [1.19-2.50], P = .004), similar for patients with and without oral anticoagulant use. The C-statistics for SSE was not statistically significantly different between CHA2DS2-VASc and CHA2DS2-VA scores (0.655 [0.639-0.671] and 0.647 [0.631-0.663], P = .258). Women had a greater risk of SSE than men at the age of > 70 years (Pinteraction = .007).

CONCLUSION

Women with AF have an increased SSE risk compared with men with higher CHA2DS2-VA scores and at the age of > 70 years. The CHA2DS2-VA scores had a numerical but nonstatistically significant difference to CHA2DS2-VASc score for overall SSE risk prediction.