Impact of CHADS 2 Score on Neurological Severity and Long-Term Outcome in Atrial Fibrillation-Related Ischemic Stroke
2
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
Background and Purpose The CHADS2 (an acronym for congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, and prior stroke or transient ischemic attack or thromboembolism) score is a widely used system for estimating the risk of stroke in patients with atrial fibrillation. However, how the CHADS2 score is related to stroke severity and outcome in patients with strokes due to atrial fibrillation has not yet been elucidated. Methods We enrolled patients with atrial fibrillation who visited our stroke center within 7 days after the onset of acute ischemic stroke between October 2002 and September 2008. CHADS2scores were categorized into three groups: 0 points, low risk; 1 or 2 points, intermediate risk; and 3-6 points, high risk. Poor neurological state was defined as follows: a National Institutes of Health Stroke Scale (NIHSS) score of ≥2, and a modified Rankin Scale (mRS) score of ≥3 at discharge. Mortality information was ascertained as at December 2008. Results A cohort of 298 patients with atrial-fibrillation-related stroke was included in this study. A high-risk CHADS2 score at admission was a powerful predictor of poor neurological outcome [for NIHSS: odds ratio (OR), 4.17; 95% confidence interval (CI), 1.76-9.87; for mRS: OR, 2.97;95% CI, 1.23-7.16] after controlling for all possible confounders. In addition, a high-risk CHADS2 score was an independent predictor of all causes of death during the follow-up [hazard ratio (HR), 3.01; 95% CI, 1.18-7.65] and vascular death (HR, 12.25; 95% CI, 1.50-99.90). Conclusions Although the CHADS2 score was originally designed to distinguish patients with a future risk of stroke, our study shows that it may also be used to predict poor neurological outcome after atrial-fibrillation-related stroke.
Abstract
Background and Purpose The CHADS2 (an acronym for congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, and prior stroke or transient ischemic attack or thromboembolism) score is a widely used system for estimating the risk of stroke in patients with atrial fibrillation. However, how the CHADS2 score is related to stroke severity and outcome in patients with strokes due to atrial fibrillation has not yet been elucidated. Methods We enrolled patients with atrial fibrillation who visited our stroke center within 7 days after the onset of acute ischemic stroke between October 2002 and September 2008. CHADS2scores were categorized into three groups: 0 points, low risk; 1 or 2 points, intermediate risk; and 3-6 points, high risk. Poor neurological state was defined as follows: a National Institutes of Health Stroke Scale (NIHSS) score of ≥2, and a modified Rankin Scale (mRS) score of ≥3 at discharge. Mortality information was ascertained as at December 2008. Results A cohort of 298 patients with atrial-fibrillation-related stroke was included in this study. A high-risk CHADS2 score at admission was a powerful predictor of poor neurological outcome [for NIHSS: odds ratio (OR), 4.17; 95% confidence interval (CI), 1.76-9.87; for mRS: OR, 2.97;95% CI, 1.23-7.16] after controlling for all possible confounders. In addition, a high-risk CHADS2 score was an independent predictor of all causes of death during the follow-up [hazard ratio (HR), 3.01; 95% CI, 1.18-7.65] and vascular death (HR, 12.25; 95% CI, 1.50-99.90). Conclusions Although the CHADS2 score was originally designed to distinguish patients with a future risk of stroke, our study shows that it may also be used to predict poor neurological outcome after atrial-fibrillation-related stroke.
참고문헌 (33)
- Fatkin D, "Relations between left atrial appendage blood flow velocity, spontaneous echocardiographic contrast and thromboembolic risk in vivo", J Am Coll Cardiol, 23, pp.961~969 (1994)
- Flegel KM, "Risk of stroke in non-rheumatic atrial fibrillation", Lancet, 1, pp.526~529 (1987)
- Wolf PA, "Atrial fibrillation: a major contributor to stroke in the elderly. The Framingham Study", Arch Intern Med, 147, pp.1561~1564 (1987)
- Wolf PA, "Atrial fibrillation as an independent risk factor for stroke: the Framingham Study", Stroke, 22, pp.983~988 (1991)
- "Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. Analysis of pooled data from five randomized controlled trials", Arch Intern Med, 154, pp.1449~1457 (1994)
- Krahn AD, "The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba Follow-Up Study", Am J Med, 98, pp.476~484 (1995)
- Lévy S, "Characterization of different subsets of atrial fibrillation in general practice in France: the ALFA study. The College of French Cardiologists", Circulation, 99, pp.3028~3035 (1999)
- Hart RG, "Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation", Ann Intern Med, 146, pp.857~867 (2007)
- Stroke Risk in Atrial Fibrillation Working Group, "Independent predictors of stroke in patients with atrial fibrillation: a systematic review", Neurology, 69, pp.546~554 (2007)
- Mackman N., "Triggers, targets and treatments for thrombosis", Nature, 451, pp.914~918 (2008)
- Connolly SJ, "Dabigatran versus warfarin in patients with atrial fibrillation", N Engl J Med, 361, pp.1139~1151 (2009)
- Krynetskiy E, "Building individualized medicine: prevention of adverse reactions to warfarin therapy", J Pharmacol Exp Ther, 322, pp.427~434 (2007)
- Palareti G, "Bleeding complications of oral anticoagulant treatment: an inception- cohort, prospective collaborative study (ISCOAT). Italian Study on Complications of Oral Anticoagulant Therapy", Lancet, 348, pp.423~428 (1996)
- Feng D, "Hemostatic state and atrial fibrillation (the Framingham Offspring Study)", Am J Cardiol, 87, pp.168~171 (2001)
- Kopecky SL, "The natural history of lone atrial fibrillation. A population- based study over three decades", N Engl J Med, 317, pp.669~674 (1987)
- Gage BF, "Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation", JAMA, 285, pp.2864~2870 (2001)
- Gage BF, "Selecting patients with atrial fibrillation for anticoagulation: stroke risk stratification in patients taking aspirin", Circulation, 110, pp.2287~2292 (2004)
- Fang MC, "Comparison of risk stratification schemes to predict thromboembolism in people with nonvalvular atrial fibrillation", J Am Coll Cardiol, 51, pp.810~815 (2008)
- Lee SH, "outcome after intracerebral hemorrhage", Neurology, 74(19), pp.1502~1510 (2010)
- 유위선, "Effects of low serum triglyceride on stroke mortality: A prospective follow-up study", ATHEROSCLEROSIS, 212, pp.299~304 (2010), ELSEVIER IRELAND LTD
- Kim BJ, "Paradoxical longevity in obese patients with intracerebral hemorrhage", NEUROLOGY, 76(6), pp.567~573 (2011), LIPPINCOTT WILLIAMS WILKINS
- "Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death. 10th revision", World Health Organization, ~ (1992)
- Young FB, "Comparison of the National Institutes of He alth Stroke Scale with disability outcome measures in acute stroke trials", Stroke, 36, pp.2187~2192 (2005)
- Weisscher N, "What should be defined as good outcome in stroke trials; a modified Rankin score of 0-1 or 0-2?", J Neurol, 255, pp.867~874 (2008)
- Barreto AD, "Thrombus burden is associated with clinical outcome after intraarterial therapy for acute ischemic stroke", Stroke, 39, pp.3231~3235 (2008)
- Puetz V, "Intracranial thrombus extent predicts clinical outcome, final infarct size and hemorrhagic transformation in ischemic stroke: the clot burden score", Int J Stroke, 3, pp.230~236 (2008)
- Lip GY, "Does hypertension confer a prothrombotic state? Virchow’s triad revisited", Circulation, 101, pp.218~220 (2000)
- Tofler GH, "Relation of the prothrombotic state to increasing age (from the Framingham Offspring Study)", Am J Cardiol, 96, pp.1280~1283 (2005)
- Grant PJ, "Diabetes mellitus as a prothrombotic condition", J Intern Med, 262, pp.157~172 (2007)
- Gustafsson C, "Coagulation factors and the increased risk of stroke in nonvalvular atrial fibrillation", Stroke, 21, pp.47~51 (1990)
- Lip GY, "Fibrinogen and fibrin D-dimer levels in paroxysmal atrial fibrillation: evidence for intermediate elevated levels of intravascular thrombogenesis", Am Heart J, 131, pp.724~730 (1996)
- Blann AD, "von Willebrand factor and soluble E-selectin in hypertension: influence of treatment and value in predicting the progression of atherosclerosis", Coron Artery Dis, 7, pp.143~147 (1996)
- Blinzler C, "Characteristics and outcome of patients with early complete neurological recovery after thrombolysis for acute ischemic stroke", Cerebrovasc Dis, 31, pp.185~190 (2011)