Prestroke CHA2DS2-VASc Score and Severity of Acute Stroke in Patients with Atrial Fibrillation

Findings from RAF Study

Monica Acciarresi, Maurizio Paciaroni, Giancarlo Agnelli, Nicola Falocci, Valeria Caso, Cecilia Becattini, Simona Marcheselli, Christina Rueckert, Alessandro Pezzini, Andrea Morotti, Paolo Costa, Alessandro Padovani, Laszló Csiba, Lilla Szabó, Sung Il Sohn, Tiziana Tassinari, Azmil H. Abdul-Rahim, Patrik Michel, Maria Cordier, Peter Vanacker & 53 others Suzette Remillard, Andrea Alberti, Michele Venti, Cataldo D'Amore, Umberto Scoditti, Licia Denti, Giovanni Orlandi, Alberto Chiti, Gino Gialdini, Paolo Bovi, Monica Carletti, Alberto Rigatelli, Jukka Putaala, Turgut Tatlisumak, Luca Masotti, Gianni Lorenzini, Rossana Tassi, Francesca Guideri, Giuseppe Martini, Georgios Tsivgoulis, Kostantinos Vadikolias, Chrissoula Liantinioti, Francesco Corea, Massimo Del Sette, Walter Ageno, Maria Luisa De Lodovici, Giorgio Bono, Antonio Baldi, Sebastiano D'Anna, Simona Sacco, Antonio Carolei, Cindy Tiseo, Davide Imberti, Dorjan Zabzuni, Boris Doronin, Vera Volodina, Domenico Consoli, Franco Galati, Alessio Pieroni, Danilo Toni, Serena Monaco, Mario Maimone Baronello, Kristian Barlinn, Lars Peder Pallesen, Jessica Kepplinger, Ulf Bodechtel, Johannes Gerber, Dirk Deleu, Gayane Melikyan, Faisal Ibrahim, Naveed Akhtar, Maria Giulia Mosconi, Kennedy R. Lees

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Abstract

Background and Purpose 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.

Original languageEnglish (US)
Pages (from-to)1363-1368
Number of pages6
JournalJournal of Stroke and Cerebrovascular Diseases
Volume26
Issue number6
DOIs
StatePublished - Jun 1 2017

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Atrial Fibrillation
Stroke
National Institutes of Health (U.S.)
Mortality
Logistic Models
Patient Admission
ROC Curve
Area Under Curve
Multivariate Analysis
Prospective Studies

All Science Journal Classification (ASJC) codes

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

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Prestroke CHA2DS2-VASc Score and Severity of Acute Stroke in Patients with Atrial Fibrillation : Findings from RAF Study. / Acciarresi, Monica; Paciaroni, Maurizio; Agnelli, Giancarlo; Falocci, Nicola; Caso, Valeria; Becattini, Cecilia; Marcheselli, Simona; Rueckert, Christina; Pezzini, Alessandro; Morotti, Andrea; Costa, Paolo; Padovani, Alessandro; Csiba, Laszló; Szabó, Lilla; Sohn, Sung Il; Tassinari, Tiziana; Abdul-Rahim, Azmil H.; Michel, Patrik; Cordier, Maria; Vanacker, Peter; Remillard, Suzette; Alberti, Andrea; Venti, Michele; D'Amore, Cataldo; Scoditti, Umberto; Denti, Licia; Orlandi, Giovanni; Chiti, Alberto; Gialdini, Gino; Bovi, Paolo; Carletti, Monica; Rigatelli, Alberto; Putaala, Jukka; Tatlisumak, Turgut; Masotti, Luca; Lorenzini, Gianni; Tassi, Rossana; Guideri, Francesca; Martini, Giuseppe; Tsivgoulis, Georgios; Vadikolias, Kostantinos; Liantinioti, Chrissoula; Corea, Francesco; Del Sette, Massimo; Ageno, Walter; De Lodovici, Maria Luisa; Bono, Giorgio; Baldi, Antonio; D'Anna, Sebastiano; Sacco, Simona; Carolei, Antonio; Tiseo, Cindy; Imberti, Davide; Zabzuni, Dorjan; Doronin, Boris; Volodina, Vera; Consoli, Domenico; Galati, Franco; Pieroni, Alessio; Toni, Danilo; Monaco, Serena; Baronello, Mario Maimone; Barlinn, Kristian; Pallesen, Lars Peder; Kepplinger, Jessica; Bodechtel, Ulf; Gerber, Johannes; Deleu, Dirk; Melikyan, Gayane; Ibrahim, Faisal; Akhtar, Naveed; Mosconi, Maria Giulia; Lees, Kennedy R.

In: Journal of Stroke and Cerebrovascular Diseases, Vol. 26, No. 6, 01.06.2017, p. 1363-1368.

Research output: Contribution to journalArticle

Acciarresi, M, Paciaroni, M, Agnelli, G, Falocci, N, Caso, V, Becattini, C, Marcheselli, S, Rueckert, C, Pezzini, A, Morotti, A, Costa, P, Padovani, A, Csiba, L, Szabó, L, Sohn, SI, Tassinari, T, Abdul-Rahim, AH, Michel, P, Cordier, M, Vanacker, P, Remillard, S, Alberti, A, Venti, M, D'Amore, C, Scoditti, U, Denti, L, Orlandi, G, Chiti, A, Gialdini, G, Bovi, P, Carletti, M, Rigatelli, A, Putaala, J, Tatlisumak, T, Masotti, L, Lorenzini, G, Tassi, R, Guideri, F, Martini, G, Tsivgoulis, G, Vadikolias, K, Liantinioti, C, Corea, F, Del Sette, M, Ageno, W, De Lodovici, ML, Bono, G, Baldi, A, D'Anna, S, Sacco, S, Carolei, A, Tiseo, C, Imberti, D, Zabzuni, D, Doronin, B, Volodina, V, Consoli, D, Galati, F, Pieroni, A, Toni, D, Monaco, S, Baronello, MM, Barlinn, K, Pallesen, LP, Kepplinger, J, Bodechtel, U, Gerber, J, Deleu, D, Melikyan, G, Ibrahim, F, Akhtar, N, Mosconi, MG & Lees, KR 2017, 'Prestroke CHA2DS2-VASc Score and Severity of Acute Stroke in Patients with Atrial Fibrillation: Findings from RAF Study', Journal of Stroke and Cerebrovascular Diseases, vol. 26, no. 6, pp. 1363-1368. https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.02.011
Acciarresi, Monica ; Paciaroni, Maurizio ; Agnelli, Giancarlo ; Falocci, Nicola ; Caso, Valeria ; Becattini, Cecilia ; Marcheselli, Simona ; Rueckert, Christina ; Pezzini, Alessandro ; Morotti, Andrea ; Costa, Paolo ; Padovani, Alessandro ; Csiba, Laszló ; Szabó, Lilla ; Sohn, Sung Il ; Tassinari, Tiziana ; Abdul-Rahim, Azmil H. ; Michel, Patrik ; Cordier, Maria ; Vanacker, Peter ; Remillard, Suzette ; Alberti, Andrea ; Venti, Michele ; D'Amore, Cataldo ; Scoditti, Umberto ; Denti, Licia ; Orlandi, Giovanni ; Chiti, Alberto ; Gialdini, Gino ; Bovi, Paolo ; Carletti, Monica ; Rigatelli, Alberto ; Putaala, Jukka ; Tatlisumak, Turgut ; Masotti, Luca ; Lorenzini, Gianni ; Tassi, Rossana ; Guideri, Francesca ; Martini, Giuseppe ; Tsivgoulis, Georgios ; Vadikolias, Kostantinos ; Liantinioti, Chrissoula ; Corea, Francesco ; Del Sette, Massimo ; Ageno, Walter ; De Lodovici, Maria Luisa ; Bono, Giorgio ; Baldi, Antonio ; D'Anna, Sebastiano ; Sacco, Simona ; Carolei, Antonio ; Tiseo, Cindy ; Imberti, Davide ; Zabzuni, Dorjan ; Doronin, Boris ; Volodina, Vera ; Consoli, Domenico ; Galati, Franco ; Pieroni, Alessio ; Toni, Danilo ; Monaco, Serena ; Baronello, Mario Maimone ; Barlinn, Kristian ; Pallesen, Lars Peder ; Kepplinger, Jessica ; Bodechtel, Ulf ; Gerber, Johannes ; Deleu, Dirk ; Melikyan, Gayane ; Ibrahim, Faisal ; Akhtar, Naveed ; Mosconi, Maria Giulia ; Lees, Kennedy R. / Prestroke CHA2DS2-VASc Score and Severity of Acute Stroke in Patients with Atrial Fibrillation : Findings from RAF Study. In: Journal of Stroke and Cerebrovascular Diseases. 2017 ; Vol. 26, No. 6. pp. 1363-1368.
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title = "Prestroke CHA2DS2-VASc Score and Severity of Acute Stroke in Patients with Atrial Fibrillation: Findings from RAF Study",
abstract = "Background and Purpose 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.",
author = "Monica Acciarresi and Maurizio Paciaroni and Giancarlo Agnelli and Nicola Falocci and Valeria Caso and Cecilia Becattini and Simona Marcheselli and Christina Rueckert and Alessandro Pezzini and Andrea Morotti and Paolo Costa and Alessandro Padovani and Laszl{\'o} Csiba and Lilla Szab{\'o} and Sohn, {Sung Il} and Tiziana Tassinari and Abdul-Rahim, {Azmil H.} and Patrik Michel and Maria Cordier and Peter Vanacker and Suzette Remillard and Andrea Alberti and Michele Venti and Cataldo D'Amore and Umberto Scoditti and Licia Denti and Giovanni Orlandi and Alberto Chiti and Gino Gialdini and Paolo Bovi and Monica Carletti and Alberto Rigatelli and Jukka Putaala and Turgut Tatlisumak and Luca Masotti and Gianni Lorenzini and Rossana Tassi and Francesca Guideri and Giuseppe Martini and Georgios Tsivgoulis and Kostantinos Vadikolias and Chrissoula Liantinioti and Francesco Corea and {Del Sette}, Massimo and Walter Ageno and {De Lodovici}, {Maria Luisa} and Giorgio Bono and Antonio Baldi and Sebastiano D'Anna and Simona Sacco and Antonio Carolei and Cindy Tiseo and Davide Imberti and Dorjan Zabzuni and Boris Doronin and Vera Volodina and Domenico Consoli and Franco Galati and Alessio Pieroni and Danilo Toni and Serena Monaco and Baronello, {Mario Maimone} and Kristian Barlinn and Pallesen, {Lars Peder} and Jessica Kepplinger and Ulf Bodechtel and Johannes Gerber and Dirk Deleu and Gayane Melikyan and Faisal Ibrahim and Naveed Akhtar and Mosconi, {Maria Giulia} and Lees, {Kennedy R.}",
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TY - JOUR

T1 - Prestroke CHA2DS2-VASc Score and Severity of Acute Stroke in Patients with Atrial Fibrillation

T2 - Findings from RAF Study

AU - Acciarresi, Monica

AU - Paciaroni, Maurizio

AU - Agnelli, Giancarlo

AU - Falocci, Nicola

AU - Caso, Valeria

AU - Becattini, Cecilia

AU - Marcheselli, Simona

AU - Rueckert, Christina

AU - Pezzini, Alessandro

AU - Morotti, Andrea

AU - Costa, Paolo

AU - Padovani, Alessandro

AU - Csiba, Laszló

AU - Szabó, Lilla

AU - Sohn, Sung Il

AU - Tassinari, Tiziana

AU - Abdul-Rahim, Azmil H.

AU - Michel, Patrik

AU - Cordier, Maria

AU - Vanacker, Peter

AU - Remillard, Suzette

AU - Alberti, Andrea

AU - Venti, Michele

AU - D'Amore, Cataldo

AU - Scoditti, Umberto

AU - Denti, Licia

AU - Orlandi, Giovanni

AU - Chiti, Alberto

AU - Gialdini, Gino

AU - Bovi, Paolo

AU - Carletti, Monica

AU - Rigatelli, Alberto

AU - Putaala, Jukka

AU - Tatlisumak, Turgut

AU - Masotti, Luca

AU - Lorenzini, Gianni

AU - Tassi, Rossana

AU - Guideri, Francesca

AU - Martini, Giuseppe

AU - Tsivgoulis, Georgios

AU - Vadikolias, Kostantinos

AU - Liantinioti, Chrissoula

AU - Corea, Francesco

AU - Del Sette, Massimo

AU - Ageno, Walter

AU - De Lodovici, Maria Luisa

AU - Bono, Giorgio

AU - Baldi, Antonio

AU - D'Anna, Sebastiano

AU - Sacco, Simona

AU - Carolei, Antonio

AU - Tiseo, Cindy

AU - Imberti, Davide

AU - Zabzuni, Dorjan

AU - Doronin, Boris

AU - Volodina, Vera

AU - Consoli, Domenico

AU - Galati, Franco

AU - Pieroni, Alessio

AU - Toni, Danilo

AU - Monaco, Serena

AU - Baronello, Mario Maimone

AU - Barlinn, Kristian

AU - Pallesen, Lars Peder

AU - Kepplinger, Jessica

AU - Bodechtel, Ulf

AU - Gerber, Johannes

AU - Deleu, Dirk

AU - Melikyan, Gayane

AU - Ibrahim, Faisal

AU - Akhtar, Naveed

AU - Mosconi, Maria Giulia

AU - Lees, Kennedy R.

PY - 2017/6/1

Y1 - 2017/6/1

N2 - Background and Purpose 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.

AB - Background and Purpose 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.

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U2 - 10.1016/j.jstrokecerebrovasdis.2017.02.011

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JO - Journal of Stroke and Cerebrovascular Diseases

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SN - 1052-3057

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