title: CHADS2 and CHA2DS2-VASc score to assess risk of stroke and death in patients paced for sick sinus syndrome.
abstract: OBJECTIVE
  The risk of stroke in patients with atrial fibrillation (AF) can be assessed by use of the CHADS2 and the CHA2DS2-VASc score system. We hypothesised that these risk scores and their individual components could also be applied to patients paced for sick sinus syndrome (SSS) to evaluate risk of stroke and death.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  All Danish pacemaker centres and selected centres in the UK and Canada.
  
  
  METHODS
  Risk factors were recorded prior to pacemaker implantation in 1415 patients with SSS participating in the Danish Multicenter Randomized Trial on Single Lead Atrial Pacing versus Dual Chamber Pacing in Sick Sinus Syndrome (Danpace) trial. Development of stroke was assessed at follow-up visits and by evaluation of patient charts. Mortality was assessed from the civil registration system.
  
  
  METHODS
  Patients were randomised to AAIR (N = 707) or DDDR pacing (N = 708).
  
  
  METHODS
  Stroke and death during follow-up.
  
  
  RESULTS
  Mean follow-up was 4.3 ± 2.5 years. In the AAIR group 6.9% patients developed stroke versus 6.1% in the DDDR group (NS). There was a significant association between CHADS2 score and the development of stroke (HR 1.41; 95% CI 1.22 to 1.64, p < 0.001). CHA2DS2-VASc score was also significantly associated with stroke (HR 1.25; CI 1.12 to 1.40, p < 0.001). CHADS2 score (HR 1.46; CI 1.36 to 1.56, p < 0.001) and CHA2DS2-VASc score (HR 1.39; CI 1.31 to 1.46, p < 0.001) were associated with mortality. Results were still significant after adjusting for AF and anticoagulation therapy.
  
  
  CONCLUSIONS
  CHADS2 and CHA2DS2-VASc score are associated with increased risk of stroke and death in patients paced for SSS irrespective of the presence of AF.
authors.affiliation: Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. hastrup@rh.dk
authors.forename: Jesper Hastrup
authors.initials: JH
authors.lastname: Svendsen
authors.forename: Jens Cosedis
authors.initials: JC
authors.lastname: Nielsen
authors.forename: Stine
authors.initials: S
authors.lastname: Darkner
authors.forename: Gunnar Vagn Hagemann
authors.initials: GV
authors.lastname: Jensen
authors.forename: Leif Spange
authors.initials: LS
authors.lastname: Mortensen
authors.forename: Henning Rud
authors.initials: HR
authors.lastname: Andersen
mesh_terms: D002170:Canada / Q000453:epidemiology; D002423:Cause of Death / Q000639:trends; D003718:Denmark / Q000453:epidemiology; D004562:Electrocardiography; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D019028:Magnetic Resonance Imaging, Cine; D010138:Pacemaker, Artificial; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index; D012804:Sick Sinus Syndrome / Q000150:complications / Q000401:mortality / Q000628:therapy*; D020521:Stroke / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D013923:Thromboembolism / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
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