CHADS2 and CHA2DS2-VASc scores for prediction of immediate and late stroke after coronary artery bypass graft surgery

Fausto Biancari, Muhammad Ali Asim Mahar, Olli-Pekka Kangasniemi
Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association 2013, 22 (8): 1304-11

BACKGROUND: We evaluated the value of CHADS2 and CHA2DS2-VASc scores in predicting immediate and late stroke after coronary artery bypass grafting (CABG).

METHODS: One thousand two hundred twenty-six patients without preoperative atrial fibrillation underwent CABG and form the basis of this community-wide study. The main outcome endpoint of this study was any ischemic stroke with occurred immediately of late after CABG.

RESULTS: During a mean follow-up of 7.2±4.5 years, 114 patients (9.3%) suffered a stroke. Freedom from stroke at 30 days and at 1-, 5-, and 10-year follow-ups were 97.5%, 96.8%, 92.0%, and 87.7%, respectively. After excluding immediate postoperative strokes, the stroke rate per 100 patients per year was 1.36. Postoperative atrial fibrillation (relative risk [RR] 1.483; 95% confidence interval [CI] 1.009-2.179), age (RR 1.039; 95% CI 1.015-1.063), history of stroke (RR 2.951; 95% CI 1.797-4.846), vascular disease (RR 1.732; 95% CI 1.111-2.700), and previous CABG (RR 3.185; 95% CI 1.268-7.997) were independent predictors of any stroke. CHADS2 (c-statistic 0.646) and CHA2DS2-VASc (c-statistic 0.668) predicted 30-day postoperative stroke (for increasing CHADS2 risk classes: 1.6%, 1.6%, and 4.8%, respectively [P=.008]; for increasing CHA2DS2-VASc risk classes: 0.9%, 0.7%, and 3.3 % [P=.043]). Both risk scores predicted late stroke. At 10 years of follow-up, freedom from stroke in high-risk CHADS2 was 80.4% and for high-risk CHA2DS2-VASc was 85.1%. These risk scoring methods predicted also any fatal stroke (c-statistics: CHADS2 0.641 [P=.040]; CHA2DS2-VASc 0.716 [P=.002]).

CONCLUSIONS: A significant number of patients may suffer stroke late after CABG, and patients with a high risk of stroke can be identified by CHADS2 and CHA2DS2-VASc scores independently from the presence of pre- or postoperative atrial fibrillation.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"