Pre-admission CHA2DS2-VASc score and outcome of patients with acute cerebrovascular events

Background The CHA2DS2-VASc score has been recommended for the assessment of thromboembolic risk in patients with atrial fibrillation. Data regarding the association between the pre-admission CHA2DS2-VASc score and the outcome of patients with stroke and TIA are scarce. We aimed to assess the predictive value of pre-admission CHA2DS2-VASc score for early risk stratification of patients with acute cerebrovascular event. Methods The study group consisted of 8309 patients (53% males, mean age of 70 ± 13.3 years) with acute stroke and TIA included in the prospective National Acute Stroke Israeli (NASIS) registry. The two-primary end-points were in-hospital mortality and severe disability at discharge. We divided the study population into 4 groups according to their pre-admission CHA2DS2-VASc score (0–1, 2–3, 4–5, > 5). Results Following a multivariate analysis odds ratios (OR) for all-cause mortality increased for CHA2DS2-VASc score > 1 (OR = 2.1 95% CI = 1.2–3.6, OR = 1.8 95% CI = 1.1–3.2, OR = 1.8 95% CI 1.1–3.3, for patients with CHA2DS2-VASc score of 2–3, 4–5 and > 5, respectively, p < 0.001). OR for severe disability (mRS 4–5) at discharge increased significantly in direct association with the CHA2DS2-VASc score (OR = 1.55 95% CI = 1.14–2.12, OR = 2.42 95% CI = 1.8–3.3, OR = 3 95% CI 2.19–4.27, for patients with CHA2DS2-VASc score of 2–3, 4–5 and > 5, respectively as compared with 0–1, p < 0.001). Each 1-point increase in the CHA2DS2-VASc score was associated with a 21% increase in the risk for severe disability. Conclusions High-risk pre-admission CHA2DS2-VASc score among patients with acute cerebrovascular events is associated with higher in-hospital mortality and severe disability at discharge.