Pre-admission CHADS2, CHA2DS2-VASc, and R2CHADS2 Scores on Severity and Functional Outcome in Acute Ischemic Stroke with Atrial Fibrillation

Background: We examined the association between pre-admission risk scores and severity on admission and functional outcome in acute ischemic stroke with atrial fibrillation (AF). Methods: Between September 2011 and April 2014, we retrospectively extracted consecutive ischemic stroke patients with AF whose pre-admission modified Rankin Scale (mRS) score was 2 or less from our prospective database. Pre-admission CHADS(2), CHA(2)DS2-VASc, and R(2)CHADS(2) scores were calculated in each patient, and their association with the National Institutes of Health Stroke Scale (NIHSS) score on admission or unfavorable outcome (mRS >= 3 at 3 months from the onset) was assessed. Results: A total of 344 patients (189 were men; age, 77.7 +/- 10.0 years) were included in the analysis. The median pre-admission CHADS(2), CHA(2)DS(2)-VASc, and R(2)CHADS(2) scores were 2, 4, and 4, respectively. NIHSS score on admission was positively correlated with pre-admission CHADS(2) (rho = .116, P = .031), CHA(2)DS(2)-VASc (rho = .166, P = .020), and R(2)CHADS(2) scores (rho = .106, P = .049). Receiver operating characteristic (ROC) curve analysis revealed that pre-admission CHADS(2) score of 2 or more (sensitivity, 80%; specificity, 45%; area under the ROC curve [AUC], .654), CHA(2)DS(2)-VASc score of 3 or more (sensitivity, 86%; specificity, 44%; AUC, .683), and R(2)CHADS(2) score of 4 or more (sensitivity, 61%; specificity, 62%; AUC, .657) were associated with unfavorable outcome. The pre-admission CHA(2)DS(2)-VASc score was better than the pre-admission CHADS(2) score in estimating unfavorable outcome (P = .017). In multivariate analysis, cutoffs of these scores, female sex, higher NIHSS score, and internal carotid artery occlusion were associated with unfavorable outcome. Conclusions: Pre-admission CHADS(2), CHA(2)DS(2)-VASc, and R(2)CHADS(2) scores were associated with onset severity and functional outcome in acute ischemic stroke with AF. (C) 2015 by National Stroke Association