Stroke and death prediction with CHA2DS2-vasc score after myocardial infarction in patients without atrial fibrillation. Issue 7 (July 2015)

• Record Type: Journal Article
• Authors: Podolecki, Tomasz; Lenarczyk, Radosław; Kowalczyk, Jacek; Swierad, Marcin; Swiatkowski, Andrzej; Jedrzejczyk, Ewa; Chodor, Piotr; Zielinska, Teresa; Kalarus, Zbigniew
• Is Part Of: Journal of cardiovascular medicine. Volume 16:Issue 7(2015:Jul.)
• Publication Date: 2015-07
• Subjects: acute myocardial infarction -- CHA2DS2-VASc score -- mortality -- stroke; Cardiology -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; Cardiology -- Periodicals; Cardiovascular Diseases -- Periodicals; 616.1005
• DOI: 10.2459/JCM.0000000000000241
• Languages: English
• ISSNs: 1558-2027

Abstract

Abstract : Aims: The CHA2 DS2 -VASc score is widely used to stratify the risk of stroke in patients with nonvalvular atrial fibrillation. The aim of the study was to assess whether the CHA2 DS2 -VASc score might be useful to identify patients at a high risk of ischemic stroke and death among individuals after acute myocardial infarction and with no history of atrial fibrillation. Methods: We analysed consecutive patients with acute myocardial infarction admitted to our centre between 2003 and 2008. On the basis of the CHA2 DS2 -VASc score, four groups were distinguished: low-risk (1 point), intermediate-risk (2–3 points), high-risk (4–5 points) and very high-risk (>5 points). Data on long-term follow-up were screened to identify patients who experienced stroke or died during remote observation. Results: Out of 2980 registry participants, 333 were excluded because of atrial fibrillation and/or ongoing therapy with oral anticoagulants. Finally, 2647 individuals were included into the analysis. An ischemic stroke occurred in 71 (2.68%) patients, whereas 439 (16.58%) died during a median follow-up of 41.5 months. The risk of stroke and death increased four-fold in the high-risk group compared with the low-risk group ( P < 0.001). Every point in the CHA2 DS2 -VASc score was independently associated with 41% increase in stroke risk and 23% increase in mortality rate (for both P < 0.001). Conclusion: The mortality rate and risk of stroke were strongly associated with the CHA2 DS2 -VASc scores. Hence, this scoring system could be useful to identify high-risk patients with no history of atrial fibrillation, in whom additional preventive measures might be beneficial to improve the outcome.