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Cardiology Xagena

All risk factors included in the CHA2DS2-VASc score are associated with stroke / transient ischemic attack in patients with recent acute coronary syndrome


Stroke is a rare but serious complication of acute coronary syndrome. At present, no specific score exists to identify patients at higher risk.
The aim of a study was to test whether each clinical variable included in the CHA2DS2-VASc score retains its predictive value in patients with recent acute coronary syndrome, irrespective of atrial fibrillation.

The meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses ( PRISMA ) and Meta-analysis of Observational Studies in Epidemiology ( MOOSE ) guidelines.
All clinical trials and observational studies presenting data on the association between stroke / transient ischemic attack incidence and at least one CHA2DS2-VASc item in patients with a recent acute coronary syndrome were considered in the analysis. Atrial fibrillation diagnosis was also considered.

The whole cohort included 558,193 patients of which 7108 ( 1.3% ) had an acute stroke and/or transient ischemic attack during follow-up ( median nine months; 1st-3rd quartile 1-12 months ).

Age and previous stroke had the highest odds ratios ( odds ratio, OR=2.60; 95% confidence interval 2.21-3.06 and OR=2.74; 95% confidence interval 2.19-3.42 respectively ), in accordance with the two-point value given in the CHA2DS2-VASc score.

All other factors were positively associated with stroke, although with lower odds ratios.

Atrial fibrillation, while present in only 11.2% of the population, confirmed its association with an increased risk of stroke and/or transient ischemic attack ( OR=2.04; 95% confidence interval 1.71-2.44 ).

In conclusion, all risk factors included in the CHA2DS2-VASc score are associated with stroke / transient ischemic attack in patients with recent acute coronary syndrome, and retain similar odds ratios to what already seen in atrial fibrillation.
The utility of CHA2DS2-VASc score for risk stratification of stroke in patients with acute coronary syndrome remains to be determined. ( Xagena )

Guerra F et al, Eur Heart J Acute Cardiovasc Care 2016; Epub ahead of print

XagenaMedicine_2016



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