Abstract
Introduction: Stroke is a rare but serious complication of acute coronary syndrome (ACS), its incidence depending on well defined risk factors. Hypothesis: To test whether clinical variables included in the CHA2DS2-VASc score keep their predictive value even in patients with recent ACS, regardless of atrial fibrillation (AF) presence. Methods: Meta-analysis was performed according to the PRISMA guidelines. MEDLINE and EMBASE were searched using the following query: (“stroke OR embolism”) AND “acute coronary syndrome” NOT “atrial fibrillation”. At the end of the selection process, 21 papers (10 randomized clinical trials and 11 observational studies) were entered into the meta-analysis. The following variables were taken into account: heart failure, hypertension, age, diabetes mellitus, previous stroke, gender and previous vascular disease. RRs was used as the main effect size. Because of the large heterogeneity in studies’ characteristics, a random-effects model was used and each variable was tested separately for randomized clinical trials and for observational studies before entering the pooled analysis. The interaction between clinical features and presence of atrial fibrillation was tested by performing a random effect meta-regression. Results: The whole cohort included 690.309 patients. Median follow-up was 9 months. Advanced age and previous stroke resulted as the most important risk factors for stroke (RR 5.89. 95% CI 4.92-6.86 for advanced age and RR 2.83. 95% CI 2.36-3.38 for previous stroke), in accordance with the two-point value that both of them have in the CHA2DS2-VASc score. All other factors were positively associated with stroke, albeit RRs were lower (heart failure RR 1.57 95% CI 1.32-1.86; hypertension RR 1.19; 95% CI 1.13-1.26; female gender RR 1.26, 95% CI 1.18-1.36; diabetes mellitus RR 1.35, 95% CI 1.25-1.46; vascular disease RR 1.35, 95% CI 1.11-1.63). Although AF confirmed its association with stroke (RR 2.13, 95% CI 1.82-2.49), its interaction on aforementioned variables was not significant. Conclusions: All risk factors included in the CHA2DS2-VASc score are associated with stroke in patients with ACS, making it an useful tool for risk stratification in patients with ACS, regardless of AF presence.
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