The association between asymptomatic coronary artery disease and CHADS2 and CHA2DS2‐VASc scores in patients with stroke. Issue 9 (5th April 2013)

• Record Type: Journal Article
• Authors: Cha, M.‐J.; Lee, H. S.; Kim, Y. D.; Nam, H. S.; Heo, J. H.
• Is Part Of: European journal of neurology. Volume 20:Issue 9(2013:Sep.)
• Page Start: 1256
• Page End: 1263
• Publication Date: 2013-04-05
• Subjects: CHA2DS2‐VAScscore -- CHADS2 score -- coronary artery disease -- stroke; Neurology -- Periodicals; Nervous system -- Diseases -- Periodicals; 616.8
• DOI: 10.1111/ene.12158
• Languages: English
• ISSNs: 1351-5101

Abstract

Abstract : Background and purpose: CHADS2 and CHA2 DS2 ‐VASc scores are measurement tools that stratify thromboembolic risk in patients with non‐valvular atrial fibrillation, and are predictive of cerebral atherosclerosis, fatal stroke and ischaemic heart disease. Patients with higher CHADS2 and CHA2 DS2 ‐VASc scores are more likely to have had an akinetic/hypokinetic left ventricular segment or a recent myocardial infarction, all of which are associated with coronary artery disease (CAD). Most of the CHADS2 score components are also risk factors for atherosclerosis. Thus, CHADS2 and CHA2 DS2 ‐VASc scores may be predictive of CAD. Methods: In all, 1733 consecutive patients with acute ischaemic stroke who underwent multi‐slice computed tomography coronary angiography were enrolled. The association of CHADS2 and CHA2 DS2 ‐VASc scores with the presence and severity of CAD was investigated. Results: Of the 1733 patients, 1220 patients (70.4%) had any degree of CAD and 576 (33.3%) had significant CAD (≥50% stenosis in at least one coronary artery). As the CHADS2 and CHA2 DS2 ‐VASc scores increased, the presence of CAD also increased ( P < 0.001). The severity of CAD was correlated with CHADS2 score (Spearman coefficient 0.229, P < 0.001) and CHA2 DS2 ‐VASc score (Spearman coefficient 0.261, P < 0.001). In multivariate analysis, after adjusting for confounding factors, CHADS2 and CHA2 DS2 ‐VASc scores ≥2 were independently associated with CAD. The CHA2 DS2 ‐VASc score was a better predictor of the presence of CAD than the CHADS2 score on area under the curve analysis. Conclusion: CHADS2 and CHA2 DS2 ‐VASc scores were predictive of the presence and severity of CAD in patients with stroke. When a patient has high CHADS2 or CHA2 DS2 ‐VASc scores, physicians should consider coronary artery evaluation.