title: Recurrent Stroke: The Value of the CHA2DS2VASc Score and the Essen Stroke Risk Score in a Nationwide Stroke Cohort.
abstract: OBJECTIVE
  The CHA2DS2VASc score and the Essen Stroke Risk Score are respectively used for risk stratification in patients with atrial fibrillation and in patients with cerebrovascular incidents. We aimed to test the ability of the 2 scores to predict stroke recurrence, death, and cardiovascular events (stroke, transient ischemic attack, myocardial infarction, or arterial thromboembolism) in a nationwide Danish cohort study, among patients with incident ischemic stroke and no atrial fibrillation.
  
  
  METHODS
  We conducted a registry-based study in patients with incident ischemic stroke and no atrial fibrillation. Patients were stratified according to the CHA2DS2VASc score and the Essen Stroke Risk Score and were followed up until stroke recurrence or death. We estimated stratified incidence rates and hazard ratios and calculated the cumulative risks.
  
  
  RESULTS
  42 182 patients with incident ischemic stroke with median age 70.1 years were included. The overall 1-year incidence rates of recurrent stroke, death, and cardiovascular events were 3.6%, 10.5%, and 6.7%, respectively. The incidence rates, the hazard ratios, and the cumulative risk of all outcomes increased with increasing risk scores. C-statistics for both risk scores were around 0.55 for 1-year stroke recurrence and cardiovascular events and correspondingly for death around 0.67 for both scores.
  
  
  CONCLUSIONS
  In this cohort of non-atrial fibrillation patients with incident ischemic stroke, increasing CHA2DS2VASc score and Essen Stroke Risk Score was associated with increasing risk of recurrent stroke, death, and cardiovascular events. Their discriminatory performance was modest and further refinements are required for clinical application.
authors: From the Department of Neurology (S.D.A., F.W.B.), Unit of Clinical Biostatistics (A.G.-R.), and Department of Cardiology (T.B.L.), Aalborg University Hospital, Aalborg, Denmark; Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark (S.D.A., A.G.-R., G.Y.H.L., T.B.L.); and University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.).
authors: Søren Due
authors: SD
authors: Andersen
authors: From the Department of Neurology (S.D.A., F.W.B.), Unit of Clinical Biostatistics (A.G.-R.), and Department of Cardiology (T.B.L.), Aalborg University Hospital, Aalborg, Denmark; Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark (S.D.A., A.G.-R., G.Y.H.L., T.B.L.); and University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.).
authors: Anders
authors: A
authors: Gorst-Rasmussen
authors: From the Department of Neurology (S.D.A., F.W.B.), Unit of Clinical Biostatistics (A.G.-R.), and Department of Cardiology (T.B.L.), Aalborg University Hospital, Aalborg, Denmark; Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark (S.D.A., A.G.-R., G.Y.H.L., T.B.L.); and University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.).
authors: Gregory Y H
authors: GY
authors: Lip
authors: From the Department of Neurology (S.D.A., F.W.B.), Unit of Clinical Biostatistics (A.G.-R.), and Department of Cardiology (T.B.L.), Aalborg University Hospital, Aalborg, Denmark; Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark (S.D.A., A.G.-R., G.Y.H.L., T.B.L.); and University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.).
authors: Flemming W
authors: FW
authors: Bach
authors: From the Department of Neurology (S.D.A., F.W.B.), Unit of Clinical Biostatistics (A.G.-R.), and Department of Cardiology (T.B.L.), Aalborg University Hospital, Aalborg, Denmark; Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark (S.D.A., A.G.-R., G.Y.H.L., T.B.L.); and University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.). tobl@rn.dk.
authors: Torben Bjerregaard
authors: TB
authors: Larsen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000453:epidemiology*; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D002546:Ischemic Attack, Transient / Q000453:epidemiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000401:mortality; D011379:Prognosis; D012008:Recurrence; D012042:Registries; D012306:Risk; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality; D013923:Thromboembolism / Q000453:epidemiology* / Q000401:mortality
keywords: CHA2DS2VASc score; Essen Stroke Risk Score; risk factors; stroke; stroke recurrence