Abstract
Background: Recent reports revealed that CHADS2 scores can be applied to assess stroke risk in patients with coronary artery disease (CAD), irrespective of atrial fibrillation (AF) presence. Furthermore, we previously reported that the score can also predict poor functional outcome of stroke after CAD. In this study, we evaluated the usefulness of CHA2DS2VASc and R2CHADS2 scores as prognostic tools for stroke patients with prior CAD. Methods: We enrolled 802 consecutive patients hospitalized with acute ischemic stroke. Inclusion criteria were (1) independent living before stroke onset, and (2) a CAD diagnosis before stroke. Pre-admission CHA2DS2VASc and R2CHADS2 scores were retrospectively calculated. Comparisons were made between patients with good (modified Rankin scale [mRS] <3) and poor (mRS ≥3) 3-month functional outcomes with regard to baseline characteristics. Furthermore, multivariate analysis was performed to assess the predictive value of CHA2DS2VASc and R2CHADS2 scores for poor outcome. Results: Of all enrolled patients, 153 patients (mean age, 74.3 years; male, 77.1%) were eligible for analysis. The patients with good and poor outcomes were found to have significant differences in CHA2DS2VASc scores (mean, 4.3 vs. 5.0, P = 0.003), R2CHADS2 scores (mean, 2.7 vs. 3.5, P = 0.003), carotid artery stenosis (23.9% vs. 41.9%, P = 0.020), intracranial artery stenosis (14.9% vs. 31.4%, P = 0.018), AF (16.4% vs. 31.4%, P = 0.031), and admission NIHSS scores (median, 4.5 vs. 11, P < 0.001). The figure shows the distributions of patients with poor outcome for the different CHA2DS2VASc and R2CHADS2 scores. According to the multivariate analysis, R2CHADS2 was a better determinant of poor functional outcome than CHA2DS2VASc (OR 1.60, 95% CI 1.18-2.24, P = 0.004; OR 1.33, 95% CI 0.99-1.81, P = 0.06, respectively). Conclusions: Both CHA2DS2VASc and R2CHADS2 scores are potentially useful tools for predicting functional outcome in stroke patients with a history of CAD.
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