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Relation of the CHADS-VASc Score to Risk of Thrombotic and Embolic Stroke in Community-Dwelling Individuals Without Atrial Fibrillation (From The Atherosclerosis Risk in Communities [ARIC] Study).

TitleRelation of the CHADS-VASc Score to Risk of Thrombotic and Embolic Stroke in Community-Dwelling Individuals Without Atrial Fibrillation (From The Atherosclerosis Risk in Communities [ARIC] Study).
Publication TypeJournal Article
Year of Publication2019
AuthorsKoene RJ, M Alraies C, Norby FL, Soliman EZ, Maheshwari A, Lip GYH, Alonso A
Secondary AuthorsChen LYee
JournalAm J Cardiol
Volume123
Issue3
Pagination402-408
Date Published2019 02 01
ISSN1879-1913
KeywordsFemale, Follow-Up Studies, Humans, Independent Living, Intracranial Embolism, Intracranial Thrombosis, Male, Middle Aged, Prospective Studies, Risk Assessment, Stroke, United States
Abstract

Recent hospital-based cohort studies found the CHADS-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 CHADS-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 CHADS-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 CHADS-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 CHADS-VASc score can assess ischemic stroke risk and has good discriminatory capacity for embolic stroke.

DOI10.1016/j.amjcard.2018.10.037
Alternate JournalAm J Cardiol
PubMed ID30527796
PubMed Central IDPMC6424356
Grant ListHHSN268201100012C / HL / NHLBI NIH HHS / United States
HHSN268201100009I / HL / NHLBI NIH HHS / United States
HHSN268201100010C / HL / NHLBI NIH HHS / United States
HHSN268201100008C / HL / NHLBI NIH HHS / United States
HHSN268201100005G / HL / NHLBI NIH HHS / United States
HHSN268201100008I / HL / NHLBI NIH HHS / United States
HHSN268201100007C / HL / NHLBI NIH HHS / United States
16EIA26410001 / / American Heart Association-American Stroke Association / United States
HHSN268201100011I / HL / NHLBI NIH HHS / United States
HHSN268201100011C / HL / NHLBI NIH HHS / United States
HHSN268201100006C / HL / NHLBI NIH HHS / United States
HHSN268201100005I / HL / NHLBI NIH HHS / United States
HHSN268201100009C / HL / NHLBI NIH HHS / United States
HHSN268201100005C / HL / NHLBI NIH HHS / United States
HHSN268201100007I / HL / NHLBI NIH HHS / United States
R01 HL141288 / HL / NHLBI NIH HHS / United States
R01 HL126637 / HL / NHLBI NIH HHS / United States