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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
23253529

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.

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