title: The CHA(2)DS(2)-VASc score reflects clinical outcomes in nonvalvular atrial fibrillation patients with an initial cardioembolic stroke.
abstract: BACKGROUND
  Whether the CHA(2)DS(2)-VASc score reflects severity or clinical outcomes in patients with an initial cardioembolic stroke associated with nonvalvular atrial fibrillation (NAVF) was investigated.
  
  
  METHODS
  This study included 327 patients hospitalized between April 2007 and March 2012 for an initial cardioembolic stroke associated with NVAF with no history of stroke. The National Institutes of Health Stroke Scale (NIHSS) score on admission and clinical outcome (modified Rankin Scale [mRS] score after 90 days) were retrospectively evaluated according to the CHA(2)DS(2)-VASc score.
  
  
  RESULTS
  CHA(2)DS(2)-VASc scores were 0, 3.1%; 1, 9.1%; 2, 24.5%; 3, 26%; 4, 20.8%; 5, 14.4%; and 6, 2.1%. The median NIHSS scores for CHA(2)DS(2)-VASc scores of 0-6 were 4.5, 8, 8, 10, 11, 17, and 23, respectively. Severity differed according to the CHA(2)DS(2)-VASc score. The clinical outcomes according to the CHA(2)DS(2)-VASc scores were as follows: score 0, mRS scores of 0-2 (80%) and 3-6 (20%); score 1, mRS scores of 0-2 (80%) and 3-6 (20%); score 2, mRS scores of 0-2 (64%) and 3-6 (36%); score 3, mRS scores of 0-2 (48%) and 3-6 (52%); score 4, mRS scores of 0-2 (28%) and 3-6 (72%); score 5, mRS scores of 0-2 (26%) and 3-6 (74%); and score 6, mRS scores of 0-2 (29%) and 3-6 (71%). The clinical outcome worsened as the CHA(2)DS(2)-VASc score increased. On logistic regression analysis, age, NIHSS score on admission, and thrombolytic therapy were related to a clinical outcome.
  
  
  CONCLUSIONS
  The severity of NVAF-induced initial cardioembolic stroke increased with higher CHA(2)DS(2)-VASc scores, and the outcomes were poor. The present study suggests that the CHA(2)DS(2)-VASc score may be useful not only for the evaluation of stroke risk but also for the prediction of clinical outcomes after stroke.
authors.affiliation: Department of Neurology, Saitama International Medical Center, Saitama Medical University, Saitama, Japan. Electronic address: ideguchi@saitama-med.ac.jp.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Deguchi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hayashi
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Ohe
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kato
authors.forename: Harumitsu
authors.initials: H
authors.lastname: Nagoya
authors.forename: Takuya
authors.initials: T
authors.lastname: Fukuoka
authors.forename: Hajime
authors.initials: H
authors.lastname: Maruyama
authors.forename: Yohsuke
authors.initials: Y
authors.lastname: Horiuchi
authors.forename: Norio
authors.initials: N
authors.lastname: Tanahashi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications*; D004617:Embolism / Q000150:complications; D005260:Female; D006331:Heart Diseases / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000628:therapy*; D015912:Thrombolytic Therapy; D016896:Treatment Outcome
keywords: CHADS(2)DS(2)-VASc score; clinical outcome; initial cardioembolic stroke; nonvalvular atrial fibrillation