title: Predictive ability of the CHADS2 and CHA2DS2-VASc scores for stroke after transcatheter aortic balloon-expandable valve implantation: an Italian Transcatheter Balloon-Expandable Valve Implantation Registry (ITER) sub-analysis.
abstract: OBJECTIVE
  Stroke incidence after transcatheter aortic valve implantation (TAVI) still represents a concern. This multicentre study aimed at investigating the hypothesis that CHADS2 and CHA2DS2-VASc scores may be used to predict perioperative stroke after TAVI.
  
  
  METHODS
  The Italian Transcatheter Balloon-Expandable Valve Implantation Registry (ITER) is a multicentre, prospective registry of patients undergoing balloon-expandable TAVI using Edwards Sapien and Sapien XT prosthesis between 2007 and 2012. The primary end-point of this study was the 30-day stroke rate. Secondary safety end-points were all the major adverse events based on Valve Academic Research Consortium (VARC-2) criteria.
  
  
  RESULTS
  One thousand nine hundred and four patients were enrolled in the registry. Mean age was 81.6 ± 6.2 years and 1147 (60.2%) patients were female; mean CHADS2and CHA2DS2-VASc scores were 2.2 ± 0.8 and 4.4 ± 1.1, respectively. Fifty-four (2.8%) patients had a stroke within 30 days. At multivariable logistic regression analysis, CHA2DS2-VASc (OR: 1.35, 95% CI: 1.03-1.78; P = 0.031) and previous cardiac surgery (OR: 1.96, 95% CI: 1.06-3.6; P = 0.033) but not CHADS2(OR: 1.05, 95% CI: 0.76-1.44; P = 0.77) were found to be independent predictors of in-hospital stroke. A CHA2DS2-VASc score ≥5 was strongly related to the occurrence of in-hospital stroke (OR: 2.51, 95% CI: 1.38-4.57; P= 0.001). However, CHA2DS2-VASc score showed only poor accuracy for in-hospital stroke with a trend for better accuracy when compared with CHADS2score (area under the curve: 0.61, 95% CI: 0.59-0.63 vs 0.51; 95% CI: 0.49-0.54, respectively, P = 0.092).
  
  
  CONCLUSIONS
  In TAVI patients, CHA2DS2-VASc provided a strong correlation for in-hospital stroke but with low accuracy. Dedicated scores to properly tailor procedures and preventive strategies are needed.
authors.affiliation: Division of Cardiology, Città della Salute e della Scienza Hospital, Torino, Italy federico.conrotto@gmail.com.
authors.forename: Federico
authors.initials: F
authors.lastname: Conrotto
authors.affiliation: Division of Cardiology, Città della Salute e della Scienza Hospital, Torino, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: D'Ascenzo
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors.forename: Augusto
authors.initials: A
authors.lastname: D'Onofrio
authors.affiliation: Centro Cardiologico Monzino, Department of Clinical Sciences and Community, University of Milano, Milano, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Agrifoglio
authors.affiliation: Ospedale San Raffaele, Milano, Italy.
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.affiliation: Ospedale San Raffaele, Milano, Italy.
authors.forename: Micaela
authors.initials: M
authors.lastname: Cioni
authors.affiliation: Divisione di Cardiochirurgia, IRCCS San Martino-IST, Genova, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Regesta
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantini
authors.affiliation: Hesperia Hospital, Modena, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Gabbieri
authors.affiliation: AOU Policlinico S. Orsola-Malpighi, Bologna, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Saia
authors.affiliation: Ospedale Ferrarotto, Università di Catania, Catania, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
authors.affiliation: AOU Integrata Verona, Verona, Italy.
authors.forename: Flavio
authors.initials: F
authors.lastname: Ribichini
authors.affiliation: AO Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Cugola
authors.affiliation: IRCCS Policinico S. Matteo, Pavia, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Aiello
authors.affiliation: AO Brotzu, Cagliari, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Sanna
authors.affiliation: AOU Policlinico Le Scotte, Siena, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Iadanza
authors.affiliation: AOUD Santa Maria della Misericordia, Udine, Italy.
authors.forename: Esmeralda
authors.initials: E
authors.lastname: Pompei
authors.affiliation: AOU Careggi, Firenze, Italy.
authors.forename: Miroslava
authors.initials: M
authors.lastname: Stolcova
authors.affiliation: Humanitas Research Hospital, Rozzano, Italy.
authors.forename: Antioco
authors.initials: A
authors.lastname: Cappai
authors.affiliation: Ospedale Cattinara, Trieste, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Minati
authors.affiliation: Clinica S. Maria, Bari, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Cassese
authors.affiliation: Clinica S. Maria, Bari, Italy.
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Martinelli
authors.affiliation: Ospedale Maggiore, Parma, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Agostinelli
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors.forename: Gino
authors.initials: G
authors.lastname: Gerosa
authors.affiliation: Division of Cardiology, Città della Salute e della Scienza Hospital, Torino, Italy.
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
authors.affiliation: Department of Surgical Sciences, Città della Salute e della Scienza Hospital, Torino, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Rinaldi
authors.affiliation: Department of Surgical Sciences, Città della Salute e della Scienza Hospital, Torino, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Salizzoni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D004452:Echocardiography; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology / Q000209:etiology*; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects* / Q000379:methods
keywords: Aortic stenosis; Stroke; TAVI