title: Prestroke CHA2DS2-VASc Score and Severity of Acute Stroke in Patients with Atrial Fibrillation: Findings from RAF Study.
abstract: OBJECTIVE
  The aim of this study was to investigate for a possible association between both prestroke CHA2DS2-VASc score and the severity of stroke at presentation, as well as disability and mortality at 90 days, in patients with acute stroke and atrial fibrillation (AF).
  
  
  METHODS
  This prospective study enrolled consecutive patients with acute ischemic stroke, AF, and assessment of prestroke CHA2DS2-VASc score. Severity of stroke was assessed on admission using the National Institutes of Health Stroke Scale (NIHSS) score (severe stroke: NIHSS ≥10). Disability and mortality at 90 days were assessed by the modified Rankin Scale (mRS <3 or ≥3). Multiple logistic regression was used to correlate prestroke CHA2DS2-VASc and severity of stroke, as well as disability and mortality at 90 days.
  
  
  RESULTS
  Of the 1020 patients included in the analysis, 606 patients had an admission NIHSS score lower and 414 patients higher than 10. At 90 days, 510 patients had mRS ≥3. A linear correlation was found between the prestroke CHA2DS2-VASc score and severity of stroke (P = .001). On multivariate analysis, CHA2DS2-VASc score correlated with severity of stroke (P = .041) and adverse functional outcome (mRS ≥3) (P = .001). A logistic regression with the receiver operating characteristic graph procedure (C-statistics) evidenced an area under the curve of .60 (P = .0001) for severe stroke. Furthermore, a correlation was found between prestroke CHA2DS2-VASc score and lesion size.
  
  
  CONCLUSIONS
  In patients with AF, in addition to the risk of stroke, a high CHA2DS2-VASc score was independently associated with both stroke severity at onset and disability and mortality at 90 days.
authors.affiliation: Stroke Unit and Division of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy. Electronic address: macun77@hotmail.com.
authors.forename: Monica
authors.initials: M
authors.lastname: Acciarresi
authors.affiliation: Stroke Unit and Division of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Paciaroni
authors.affiliation: Stroke Unit and Division of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy.
authors.forename: Giancarlo
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authors.lastname: Agnelli
authors.affiliation: Stroke Unit and Division of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy.
authors.forename: Nicola
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authors.lastname: Falocci
authors.affiliation: Stroke Unit and Division of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy.
authors.forename: Valeria
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authors.lastname: Caso
authors.affiliation: Stroke Unit and Division of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy.
authors.forename: Cecilia
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authors.lastname: Becattini
authors.affiliation: Neurologia d'urgenza e Stroke Unit, Istituto Clinico Humanitas, Rozzano, Milano, Italy.
authors.forename: Simona
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authors.affiliation: Abteilung für Neurologie, Oberschwabenklinik gGmbH, Ravensburg, Germany.
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authors.affiliation: Department of Clinical and Experimental Sciences, Neurology Unit, University "Health and Wealth" of Brescia, Brescia, Italy.
authors.forename: Alessandro
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authors.lastname: Pezzini
authors.affiliation: Department of Clinical and Experimental Sciences, Neurology Unit, University "Health and Wealth" of Brescia, Brescia, Italy.
authors.forename: Andrea
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authors.affiliation: Department of Clinical and Experimental Sciences, Neurology Unit, University "Health and Wealth" of Brescia, Brescia, Italy.
authors.forename: Paolo
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authors.affiliation: Department of Clinical and Experimental Sciences, Neurology Unit, University "Health and Wealth" of Brescia, Brescia, Italy.
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authors.affiliation: Stroke Unit, University of Debrecen, Debrecen, Hungary.
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authors.affiliation: Stroke Unit, University of Debrecen, Debrecen, Hungary.
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authors.forename: Sung-Il
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authors.forename: Tiziana
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authors.affiliation: Medical School and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Azmil H
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authors.forename: Patrik
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authors.affiliation: Centre Cérébrovasculaire, Service de Neurologie, Département des Neurosciences Cliniques Centre Hopitalier Universitaire Vaudois, Lausanne, Switzerland.
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authors.affiliation: Centre Cérébrovasculaire, Service de Neurologie, Département des Neurosciences Cliniques Centre Hopitalier Universitaire Vaudois, Lausanne, Switzerland.
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authors.lastname: Remillard
authors.affiliation: Stroke Unit and Division of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy.
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authors.affiliation: Stroke Unit and Division of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy.
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authors.affiliation: Stroke Unit and Division of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy.
authors.forename: Cataldo
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authors.forename: Umberto
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authors.affiliation: Stroke Unit, Dipartimento Geriatrico Riabilitativo, University of Parma, Parma, Italy.
authors.forename: Licia
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authors.lastname: Denti
authors.affiliation: Clinica Neurologica, Azienda Ospedaliero-Universitaria, Pisa, Italy.
authors.forename: Giovanni
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authors.affiliation: Clinica Neurologica, Azienda Ospedaliero-Universitaria, Pisa, Italy.
authors.forename: Alberto
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authors.affiliation: Clinica Neurologica, Azienda Ospedaliero-Universitaria, Pisa, Italy.
authors.forename: Gino
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authors.affiliation: SSO Stroke Unit, UO Neurologia, DAI di Neuroscienze, AOUI Verona, Italy.
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authors.affiliation: SSO Stroke Unit, UO Neurologia, DAI di Neuroscienze, AOUI Verona, Italy.
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authors.affiliation: Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Jukka
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authors.affiliation: Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland; Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Turgut
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authors.affiliation: Department of Internal Medicine, Cecina Hospital, Cecina, Livorno, Italy.
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authors.affiliation: Department of Internal Medicine, Cecina Hospital, Cecina, Livorno, Italy.
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authors.affiliation: Stroke Unit, AOU Senese, Siena, Italy.
authors.forename: Giuseppe
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authors.affiliation: Department of Neurology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece; International Clinic Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic; Second Department of Neurology, "Attikon" Hospital, University of Athens, School of Medicine, Athens, Greece.
authors.forename: Georgios
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authors.affiliation: Department of Neurology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece.
authors.forename: Kostantinos
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authors.affiliation: Second Department of Neurology, "Attikon" Hospital, University of Athens, School of Medicine, Athens, Greece.
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authors.affiliation: Department of Internal Medicine, Insubria University, Varese, Italy.
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authors.affiliation: Stroke Unit, Neurology, Insubria University, Varese, Italy.
authors.forename: Maria Luisa
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authors.affiliation: Stroke Unit, Neurology, Insubria University, Varese, Italy.
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authors.affiliation: Stroke Unit, Ospedale di Portogruaro, Portogruaro, Venice, Italy.
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authors.affiliation: Department of Neurology, University of L'Aquila, L'Aquila, Italy.
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authors.affiliation: Department of Neurology, University of L'Aquila, L'Aquila, Italy.
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authors.affiliation: Municipal Budgetary Healthcare Institution of Novosibirsk, City Clinical Hospital #1, Novosibirsk, Russia.
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authors.forename: Mario Maimone
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authors.affiliation: Department of Neurology, Dresden University Stroke Center, Dresden, Germany.
authors.forename: Lars-Peder
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authors.affiliation: Department of Neurology, Dresden University Stroke Center, Dresden, Germany.
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authors.affiliation: Department of Neurology, Dresden University Stroke Center, Dresden, Germany.
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authors.affiliation: Department of Neurology, Dresden University Stroke Center, Dresden, Germany.
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authors.affiliation: Neurology, Hamad Medical Corporation, Doha, Qatar.
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authors.affiliation: Neurology, Hamad Medical Corporation, Doha, Qatar.
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authors.affiliation: Neurology, Hamad Medical Corporation, Doha, Qatar.
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authors.affiliation: Neurology, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Naveed
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authors.affiliation: Stroke Unit and Division of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy.
authors.forename: Maria Giulia
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authors.affiliation: Medical School and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.
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mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001208:Asia; D001281:Atrial Fibrillation / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D016009:Chi-Square Distribution; D003661:Decision Support Techniques; D004185:Disability Evaluation; D005060:Europe; D005260:Female; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D013997:Time Factors; D014057:Tomography, X-Ray Computed
keywords: CHA(2)DS(2)-VASc score; Ischemic stroke; atrial fibrillation; outcome; scores; severity