Recent hospital-based cohort studies found the CHA2DS2-VASc score to be associated with ischemic stroke in individuals without atrial fibrillation
(AF). Our aim was to determine the distribution of embolic and thrombotic strokes
and association with the CHA2DS2-VASc score, among community-dwelling individuals without AF. We included participants
from the Atherosclerosis Risk in Communities (ARIC) Study who attended visit 4 (1996
to 1998) and had no previous AF, stroke, or anticoagulant use (n = 10,671). During
follow-up through 2008, incident AF cases (n = 760) and participants who started warfarin
were censored. Incident AF was ascertained from study electrocardiograms and hospital
discharge diagnosis codes, and stroke was physician-adjudicated. After 10 years of
follow-up, 280 ischemic strokes were identified, of which 146 were thrombotic and
57 embolic. The hazard ratios (95% confidence intervals [CI]) for thrombotic stroke
were 1 (reference), 1.71 (1.13 to 2.59), 2.92 (1.91 to 4.45), 3.22 (1.70 to 6.11),
and 1.25 (0.17 to 9.09), with CHA2DS2-VASc scores of 0 to 1, 2, 3, 4, and ≥5, respectively. The hazard ratios (95% CI)
for embolic stroke were 1 (ref), 4.91 (2.10 to 11.5), 7.07 (2.93 to 17.0), 14.8 (5.50
to 39.6), and 15.2 (3.16 to 73.3), with CHA2DS2-VASc scores of 0 to 1, 2, 3, 4, and ≥5, respectively. A receiver-operating characteristic
model had a C-statistic of 0.65 for ischemic stroke, 0.61 for thrombotic stroke, and
0.71 for embolic stroke. In conclusion, in community-dwelling individuals without
AF, the CHA2DS2-VASc score can assess ischemic stroke risk and has good discriminatory capacity for
embolic stroke.
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References
- Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach.Chest. 2010; 137 (Available from): 263-272
- Usefulness of the CHA2DS2-VASc score to predict postoperative stroke in patients having cardiac surgery independent of atrial fibrillation.Am J Cardiol. 2015; 115 (Available from): 758-762
- Comparative assessment of published atrial fibrillation stroke risk stratification schemes for predicting stroke, in a non-atrial fibrillation population: the Chin-Shan Community Cohort Study.Int J Cardiol. 2013; 168 (Available from): 414-419
- Assessment of the CHA2DS2-VASc score in predicting ischemic stroke, thromboembolism, and death in patients with heart failure with and without atrial fibrillation.JAMA. 2015; 314 (Available from): 1030
- CHADS2, CHA2DS2-VASc, and long-term stroke outcome in patients without atrial fibrillation.Neurology. 2013; 80 (Available from): 1009-1017
- Prediction of stroke or TIA in patients without atrial fibrillation using CHADS2 and CHA2 DS2-VASc scores.Heart. 2014; 100 (Available from): 1524-1530
- The Atherosclerosis Risk in Communities (ARIC) Study: design and objectives. The ARIC investigators.Am J Epidemiol. 1989; 129 (Available from): 687-702
- Incidence of atrial fibrillation in whites and African-Americans: the Atherosclerosis Risk in Communities (ARIC) study.Am Heart J. 2009; 158 (Available from): 111-117
- Electrocardiographic and clinical predictors separating atherosclerotic sudden cardiac death from incident coronary heart disease.Heart. 2011; 97 (Available from): 1597-1601
- Comparable ascertainment of newly-diagnosed atrial fibrillation using active cohort follow-up versus surveillance of centers for medicare and medicaid services in the atherosclerosis risk in communities study.PLoS One. 2014; 9 (Available from): e94321
- Abnormal P-wave axis and ischemic stroke.Stroke. 2017; 48 (Available from): 2060-2065
The National Survey of Stroke. National Institute of Neurological and Communicative Disorders and Stroke. Stroke.;12:I1–91. Available from: http://www.ncbi.nlm.nih.gov/pubmed/7222163
- 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society.Circulation. 2014; 130 (Available from): 2071-2104
- Rate- and rhythm-control therapies in patients with atrial fibrillation.Ann Intern Med. 2014; 160 (Available from): 760
- Temporal relationship of atrial tachyarrhythmias, cerebrovascular events, and systemic emboli based on stored device data: a subgroup analysis of TRENDS.Hear Rhythm. 2011; 8 (Available from): 1416-1423
- Temporal relationship between subclinical atrial fibrillation and embolic events.Circulation. 2014; 129 (Available from): 2094-2099
- Paroxysmal supraventricular tachycardia and the risk of ischemic stroke.Stroke. 2013; 44 (Available from): 1550-1554
- P-wave morphology and the risk of incident ischemic stroke in the multi-ethnic study of atherosclerosis.Stroke. 2014; 45 (Available from): 2786-2788
- CHA2 DS2-VASc score, left atrial size and atrial fibrillation as stroke risk factors in the Tromsø Study.Open Hear. 2016; 3 (Available from)e000439
- Stroke incidence among white, black, and Hispanic residents of an urban community: the Northern Manhattan Stroke Study.Am J Epidemiol. 1998; 147 (Available from): 259-268
- Cardioembolic stroke.Circ Res. 2017; 120 (Available from): 514-526
- Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study.JAMA. 1994; 271 (Available from): 840-844
- Incidence of and risk factors for atrial fibrillation in older adults.Circulation. 1997; 96 (Available from): 2455-2461
- Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence.Circulation. 2006; 114 (Available from): 119-125
Article info
Publication history
Published online: November 06, 2018
Received in revised form:
October 27,
2018
Received:
August 26,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
