CHA2DS2–VASc score predicts short- and long-term outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis

Abstract

The CHA2DS2-VASc score is a validated tool to assess the thromboembolic risk in patients with atrial fibrillation. Pre-stroke CHA2DS2-VASc score may predict outcome in patients with acute ischemic stroke (AIS) without atrial fibrillation. The aim of this study was to investigate if the pre-stroke CHA2DS2-VASc score is able to predict short- and long-term outcomes in AIS patients treated with intravenous thrombolysis (IVT). The study group consisted of 256 consecutive patients admitted to the Udine University Hospital with AIS and underwent IVT between January 2015 to March 2017. The pre-stroke CHA2DS2-VASc score for each patient was calculated from the collected baseline data. Patients were classified into three groups according to their pre-stroke CHA2DS2-VASc score: a score of 0 of 1, a score of 2 or 3 and a score above 3. Primary outcome measures were: rate of favorable outcome at 90-days and at 1-year, and mortality at 90-days and at 1-year. Data on functional outcome and mortality 1year after stroke were collected in 165 patients (65% of the entire sample). Favorable outcome was defined as a modified Rankin Scale score ≤ 2. Compared with the CHA2DS2-VASc score 0-1 group, patients with higher CHA2DS2-VASc scores had a worse outcome and a higher mortality 3months and 1year after stroke. The diagnostic performance of the CHA2DS2-VASc score as judged with AUC-ROC was 0.70 (95% CI, 0.64-0.76; p < 0.001) for favorable outcome at 90-days, 0.78 (95% CI, 0.71-0.85; p < 0.001) for favorable outcome at 1-year, 0.71 (95% CI 0.61-0.79) for mortality at 90-days, 0.73 (95% CI 0.64-0.80; p < 0.001) for mortality at 1-year. Pre-stroke CHA2DS2-VASc score represents a good predictor for short- and long-term outcomes in AIS patients treated with IVT.