scholarly journals Association between CHADS2, CHA2DS2-VASc, ATRIA, and Essen Stroke Risk Scores and Unsuccessful Recanalization after Endovascular Thrombectomy in Acute Ischemic Stroke Patients

2022 ◽  
Vol 11 (1) ◽  
pp. 274
Author(s):  
Hyung Jun Kim ◽  
Moo-Seok Park ◽  
Joonsang Yoo ◽  
Young Dae Kim ◽  
Hyungjong Park ◽  
...  
Keyword(s):  
Selection Criteria ◽  
Stroke Risk ◽  
Risk Scores ◽  
Univariable Analysis ◽  
Stroke Patients ◽  
Chads2 Score ◽  
Endovascular Thrombectomy ◽  
Included Patient ◽  
Auc Value ◽  
Multicenter Registry

Background: The CHADS2, CHA2DS2-VASc, ATRIA, and Essen scores have been developed for predicting vascular outcomes in stroke patients. We investigated the association between these stroke risk scores and unsuccessful recanalization after endovascular thrombectomy (EVT). Methods: From the nationwide multicenter registry (Selection Criteria in Endovascular Thrombectomy and Thrombolytic therapy (SECRET)) (Clinicaltrials.gov NCT02964052), we consecutively included 501 patients who underwent EVT. We identified pre-admission stroke risk scores in each included patient. Results: Among 501 patients who underwent EVT, 410 (81.8%) patients achieved successful recanalization (mTICI ≥ 2b). Adjusting for body mass index and p < 0.1 in univariable analysis revealed the association between all stroke risk scores and unsuccessful recanalization (CHADS2 score: odds ratio (OR) 1.551, 95% confidence interval (CI) 1.198–2.009, p = 0.001; CHA2DS2VASc score: OR 1.269, 95% CI 1.080–1.492, p = 0.004; ATRIA score: OR 1.089, 95% CI 1.011–1.174, p = 0.024; and Essen score: OR 1.469, 95% CI 1.167–1.849, p = 0.001). The CHADS2 score had the highest AUC value and differed significantly only from the Essen score (AUC of CHADS2 score; 0.618, 95% CI 0.554–0.681). Conclusion: All stroke risk scores were associated with unsuccessful recanalization after EVT. Our study suggests that these stroke risk scores could be used to predict recanalization in stroke patients undergoing EVT.

Pre-Admission CHADS2 and CHA2DS2-VASc Scores on Early Neurological Worsening

2021 ◽  
pp. 1-8
Author(s):  
Ki-Woong Nam ◽  
Chi Kyung Kim ◽  
Sungwook Yu ◽  
Jong-Won Chung ◽  
Oh Young Bang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Stroke Risk ◽  
Multivariable Analysis ◽  
National Institutes Of Health ◽  
Risk Scores ◽  
Stroke Patients ◽  
Nihss Score ◽  
Early Neurological Deterioration ◽  
Close Relationship ◽  
The Relationship

<b><i>Background:</i></b> Stroke risk scores (CHADS<sub>2</sub> and CHA<sub>2</sub>DS<sub>2</sub>-VASc) not only predict the risk of stroke in atrial fibrillation (AF) patients, but have also been associated with prognosis after stroke. <b><i>Objective:</i></b> The aim of this study was to evaluate the relationship between stroke risk scores and early neurological deterioration (END) in ischemic stroke patients with AF. <b><i>Methods:</i></b> We included consecutive ischemic stroke patients with AF admitted between January 2013 and December 2015. CHADS<sub>2</sub> and CHA<sub>2</sub>DS<sub>2</sub>-VASc scores were calculated using the established scoring system. END was defined as an increase ≥2 on the total National Institutes of Health Stroke Scale (NIHSS) score or ≥1 on the motor NIHSS score within the first 72 h of admission. <b><i>Results:</i></b> A total of 2,099 ischemic stroke patients with AF were included. In multivariable analysis, CHA<sub>2</sub>DS<sub>2</sub>-VASc score (adjusted odds ratio [aOR] = 1.17, 95% confidence interval [CI] = 1.04–1.31) was significantly associated with END after adjusting for confounders. Initial NIHSS score, use of anticoagulants, and intracranial atherosclerosis (ICAS) were also found to be closely associated with END, independent of the CHA<sub>2</sub>DS<sub>2</sub>-VASc score. Multivariable analysis stratified by the presence of ICAS demonstrated that both CHA<sub>2</sub>DS<sub>2</sub>-VASc (aOR = 1.20, 95% CI = 1.04–1.38) and CHADS<sub>2</sub> scores (aOR = 1.24, 95% CI = 1.01–1.52) were closely related to END in only patients with ICAS. In patients without ICAS, neither of the risk scores were associated with END. <b><i>Conclusions:</i></b> High CHA<sub>2</sub>DS<sub>2</sub>-VASc score was associated with END in ischemic stroke patients with AF. This close relationship is more pronounced in patients with ICAS.

Abstract 18703: Impact of the 2014 Atrial Fibrillation Guideline on the Proportion of Patients Recommended for Oral Anticoagulation

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Emily C O’Brien ◽  
Sunghee Kim ◽  
Paul L Hess ◽  
James V Freeman ◽  
Laine Thomas ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulation ◽  
Stroke Risk ◽  
Treatment Guidelines ◽  
Treatment Guideline ◽  
Risk Scores ◽  
Community Based ◽  
Chads2 Score ◽  
Number Of Patients ◽  
Using Data

Introduction: In 2014, the AHA/ACC/HRS published new atrial fibrillation (AF) treatment guidelines recommending use of a refined stroke risk score and revised threshold for oral anticoagulation (OAC) initiation. Methods: Using data from ORBIT-AF, an ongoing, national, outpatient AF registry conducted at 176 sites, we examined changes in the number of patients qualifying for OAC based on clinical stroke risk scores under 2011 ACCF/AHA/HRS versus 2014 AHA/ACC/HRS guidelines. Patients were considered recommended for OAC under the 2011 guideline with a CHADS2 score >=2 and under the 2014 guideline with a CHA2DS2-VASC score >=2. We reported the fraction of patients treated with OAC (warfarin or dabigatran) among patients qualifying for OAC under each guideline. Results: From 2009 - 2010, 10132 patients were enrolled in ORBIT-AF (median age [IQR] = 75 years [67 - 82]; 42.3% female). The proportion of patients qualifying for OAC increased from 71.8% under the 2011 guideline to 90.8% under the 2014 guideline (Figure). For patients under the age of 65, the proportion qualifying for treatment with OAC increased from 43.1% to 60.6%. Similar increases were observed for patients over the age of 65: 79.1% indicated for OAC under the 2011 guideline, compared with 98.5% under the 2014 guideline. There were 97.7% of women who qualified for OAC under the 2014 guideline, compared with 76.7% under the 2011 guideline. The fraction of indicated patients who were not receiving OAC increased under the 2014 guideline (21.9% vs. 19.9% under the 2011 guideline), with the highest undertreatment rates for patients younger than 65 (25.4%). Conclusions: The 2014 AF treatment guideline substantially increased the proportion of patients who qualified for OAC, with near-universal indication for women and for patients older than 65. Under the 2014 guideline, approximately 22% of the indicated patients in our community-based cohort did not receive OAC.

The CHADS2 score predicts ischemic stroke in chronic heart failure patients without atrial fibrillation: comparison to other stroke risk scores

2016 ◽  
Vol 32 (2) ◽  
pp. 193-200 ◽  
Author(s):  
Takumi Kondo ◽  
Takahisa Yamada ◽  
Takashi Morita ◽  
Yoshio Furukawa ◽  
Shunsuke Tamaki ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Chronic Heart Failure ◽  
Stroke Risk ◽  
Risk Scores ◽  
Chads2 Score ◽  
Heart Failure Patients

Abstract 274: Prevalence of undiagnosed non-valvular atrial fibrillation in the United States

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Mintu P Turakhia ◽  
Jason Shafrin ◽  
Katalin Bognar ◽  
Jeffrey B Brown ◽  
Jeffrey Trocio ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
High Risk ◽  
The Elderly ◽  
The United States ◽  
Risk Scores ◽  
Chads2 Score ◽  
Aged Patients ◽  
Number Of Patients ◽  
Working Age ◽  
Back Calculation

Background: Because atrial fibrillation (AF) is often asymptomatic, clinically silent and therefore undiagnosed, the prevalence of AF is difficult to estimate. In fact, ischemic stroke is often the first clinical sign of AF among previously undiagnosed patients. In this study, we estimated the prevalence of undiagnosed AF using a back-calculation approach that relies on the fact that AF causes stroke but causality generally does not run from stroke to AF. Methods: We first estimated the prevalence of diagnosed non-valvular AF in the elderly (65+) and working age (18-64) U.S. population from a 5% Medicare sample and an OptumInsight commercial claims database from 2004-2010 using validated ICD9 algorithms. To estimate the prevalence of undiagnosed non-valvular AF, our back-calculation methodology used two measured inputs: (i) the number of patients who are diagnosed with new non-valvular AF in the current or subsequent quarter after a stroke; (ii) the probability that patients with non-valvular AF have a stroke, based on CHADS2 risk scores. We confirmed calibration by comparing our prevalence estimates of diagnosed AF with prior Medicare and commercial claims analyses. Results: Between 2005 and 2009, the estimated prevalence of AF gradually increased, reaching 9.9% of the elderly U.S. population and 0.88% of the working aged population by 2009. Among the Medicare AF cases in 2009, 11% of these cases (1.1% out of 9.9%) were undiagnosed; among working aged patients with AF, 8% of cases (0.07% out of 0.88%) were undiagnosed. In addition, a large share of the undiagnosed cases was at high risk of stroke. Among the undiagnosed AF cases for elderly and working age adults, 26% and 37%, respectively have a CHADS2 score of 1, and 68% and 26% have a CHADS2 score of 2+. Conclusions: Among elderly and working adult U.S. populations, a substantial proportion of individuals with undiagnosed AF have moderate to high risk of stroke. Screening for AF could favorably impact the disease burden.

Abstract W P386: Matrix Metalloproteinase Levels May Mediate Ischemic Stroke Incidence and Recovery in Stroke Patients with Metabolic Syndrome

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Ashley B Petrone ◽  
Taura L Barr ◽  
Kelly Devlin ◽  
Sara B Fournier ◽  
Evan D Devallance ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Stroke Risk ◽  
Plasma Concentrations ◽  
Stroke Recovery ◽  
Ultrasound Images ◽  
Stroke Patients ◽  
Stroke Incidence ◽  
The Metabolic Syndrome ◽  
Diabetes Status ◽  
Increased Risk

Intro: The metabolic syndrome (MetS) is highly prevalent in the US characterized by a combination of risk factors that can lead to cardiovascular disease (CVD). While the association between CVD, inflammation, and stroke risk has been characterized, the immune mechanisms underlying increased risk of stroke in MetS is unclear. While stroke risk is higher among MetS, MetS individuals tend to have better stroke recovery than controls. The immune response may mediate these paradoxical observations in stroke. In particular, matrix metalloproteinases (MMP) enzymes play a role in stroke incidence and recovery. Similar to MetS, MMPs have a dual role in stroke, as they are harmful immediately after stroke, but play a vital role in brain repair and recovery following stroke. We hypothesize that elevated levels of MMPs in MetS may account for the paradoxical increased stroke risk, yet better recovery seen in stroke patients with MetS. Methods: MMP protein concentrations were obtained from fasting venous samples and quantified using a Multi-Analyte Profiling Kit (Millipore) on the Luminex®. Each subject was assigned a metabolic risk score (MRS) based on sex, age, SBP, treatment for hypertension, smoking and diabetes status, HDL, and total cholesterol. B-mode ultrasound images of the right common carotid artery were obtained to measure intima-medial thickness (cIMT). Spearman correlations were used to measure the relationship between MRS, cIMT, and MMP levels. Results: In n=68 subjects (60% female) with a mean age of 48+14 yrs, MRS of 25+12, and cIMT of 0.57+0.12 mm. MRS was significantly correlated with cIMT (r=0.39, p< .001). Further, cIMT was positively correlated with MMP1 (r=0.025, p=0.04), MMP7 (r=0.5, p=0.01), and MMP9 (r=0.31, p=0.01). Conclusion: Plasma concentrations of MMP1, 7, and 9 were significantly correlated with cIMT, indicating that increased severity of MetS is associated with increased inflammation. Elevated MMP protein levels may account for the increased stroke risk, yet better recovery seen in stroke patients with MetS.

Abstract WP328: A Nurse-Led Initiative Improves Adherence Rates for Stroke Follow-up and Blood Pressure Management

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Darren T Larsen ◽  
Helmi L Lutsep
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Stroke Prevention ◽  
Stroke Risk ◽  
Retention Rates ◽  
Matched Cohort ◽  
Stroke Patients ◽  
Stroke Risk Factor ◽  
Chi Square Analysis

Background and Issues Aggressive management of vascular risk factors reduces stroke rates. It is unknown whether structured nurse-led follow up increases adherence rates for stroke patients after hospital discharge. Purpose The purpose of this program is to improve secondary stroke risk factor management by instituting a nurse-led initiative called Stroke Therapy, Education, Prevention (STEP). Methods The pilot STEP program was based on protocols used for other stroke prevention trials. This nurse-led program includes inpatient initiation and outpatient maintenance of pharmacologic and lifestyle goals for stroke patients. Eligible patients have a non-disabling ischemic stroke or TIA and are without insurance restrictions and live within a distance allowing return to clinic for follow up. Prior to discharge, the STEP nurse completes patient education, and reviews outpatient goals. The STEP nurse makes phone contact with the patient 7-10 days after discharge to review medication compliance and reinforce education. At 30 days post discharge patients are seen in clinic by the STEP nurse where a resting blood pressure (BP) is measured. If the patient does not meet targets (<140 SBP or <130 SBP for DM) medications are adjusted by a stroke neurologist. We undertook a retrospective chart review of a consecutive cohort of patients matched to STEP eligibility criteria to determine whether the program improved retention rates and BP management. Chi-Square analysis was used to compare visit adherence and percentage achieving goal BPs at 30 days. Results In the STEP group 25/32(78%) patients completed the 30 day follow up compared to 14/32 (44%) patients in the historical matched cohort (p=0.0048). Target BP was achieved in 13/25(52%) STEP patients and 5/14 (36%) matched cohort patients (p=0.32) returning to clinic. Overall, target BP was achieved in 13/32 (41%) and 5/32 (16%) respectively (p=0.026). Conclusions In conclusion, follow up adherence and BP management in the group as a whole was better in the nurse-led model and is recommended for secondary stroke prevention. Long term follow up with this model may further increase in-target rates of BP control and other stroke risk factors.

Stroke Risk Scores as Predictors of Severe Outcomes in Atrial Fibrillation

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Andreea Cristina Ivănescu ◽  
Cătălin Adrian Buzea ◽  
Caterina Delcea ◽  
Gheorghe Andrei Dan
Keyword(s):  
Atrial Fibrillation ◽  
Stroke Risk ◽  
Risk Scores
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