Stroke and death prediction with CHA2DS2-vasc score after myocardial infarction in patients without atrial fibrillation

Aims The CHA(2)DS(2)-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 CHA(2)DS(2)-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 CHA(2)DS(2)-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 CHA(2)DS(2)-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 CHA(2)DS(2)-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.