title: Usefulness of the CHA2DS2VASc score to predict postoperative stroke in patients having cardiac surgery independent of atrial fibrillation.
abstract: Despite its association with cardioembolic stroke, atrial fibrillation (AF) appears to be inconsistent as a risk factor for postoperative strokes in patients who underwent cardiac surgery. Furthermore, the relation between AF and the CHA2DS2VASc score has not been definitively established with respect to postoperative stroke. We retrospectively analyzed the records of all cardiac surgery performed at our institution between January 2008 and July 2013. Baseline characteristics, operative data, and postoperative outcomes were compared in patients who developed stroke with those who did not. Previously recognized stroke risk factors, including AF, were analyzed along with the CHADS2 and CHA2DS2VASc scores. A total of 3,492 consecutive patients were identified, of which 2,077 (60%) underwent valve surgery, 915 (26%) had coronary artery bypass grafting, 399 (11%) underwent combined coronary artery bypass grafting and valve procedures, and 101 (3%) had other cardiac operations. Postoperative ischemic strokes occurred in 44 patients (1.2%). The development of a stroke was associated with older age (74 ± 12 vs 69 ± 12, p = 0.008), preoperative antiplatelet medication use (38.6% vs 24.5%, p = 0.043), congestive heart failure (37% vs 20%, p = 0.002), and greater CHADS2 (2.48 ± 1.3 vs 1.98 ± 1.1, p = 0.015) and CHA2DS2VASc scores (4.2 ± 1.8 vs 3.4 ± 1.6, p = 0.002). Multivariable analysis demonstrated that the CHA2DS2VASc score was the only independent predictor of postoperative strokes (odds ratio 1.25; 95% confidence interval 1.05 to 1.5, p = 0.014). In conclusion, the CHA2DS2VASc score appears to predict postoperative strokes independent of the presence of AF.
authors.affiliation: Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, Florida.
authors.forename: Julio G
authors.initials: JG
authors.lastname: Peguero
authors.affiliation: Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, Florida.
authors.forename: Omar
authors.initials: O
authors.lastname: Issa
authors.affiliation: Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, Florida.
authors.forename: Carlos
authors.initials: C
authors.lastname: Podesta
authors.affiliation: Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, Florida.
authors.forename: Hany M
authors.initials: HM
authors.lastname: Elmahdy
authors.affiliation: Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, Florida. Electronic address: osantana@msmc.com.
authors.forename: Orlando
authors.initials: O
authors.lastname: Santana
authors.affiliation: Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, Florida.
authors.forename: Gervasio A
authors.initials: GA
authors.lastname: Lamas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D001026:Coronary Artery Bypass / Q000009:adverse effects; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012107:Research Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000628:therapy; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome