Predictive Value Of CHADS₂ And CHA₂DS₂-VASc Score In Stroke Patients Without Atrial Fibrillation

Background:In China,there are nearly 150-200 million patients with ischemic stroke every year,and atrial fibrillation?AF?is one of the most important risk factors for stroke.In these patients,the European Society of Cardiology?ESC?guidelines for the management of atrial fibrillation respectively in 2006 and 2010 in the proposed application of CHADS₂ score and CHA₂DS₂-VASc score,the risk of ischemic stroke in patients with non valvular atrial fibrillation may occur in the forecast,and to guide the clinical treatment for these patients and clinicians.The current CHADS₂ score and CHA₂DS₂-VASc score have been widely used to assess the risk of ischemic stroke in patients with non valvular atrial fibrillation.In addition,according to 2016?ESC/American Heart Association?ACC?/American Heart Association?AHA??guidelines for the most recent atrial fibrillation?AF?,it is suggested that anticoagulation therapy should be considered for patients with high risk of stroke after catheter ablation of atrial fibrillation.It is suggested that even with sinus rhythm,CHADS₂ score and CHA₂DS₂-VASc high-risk patients may further affect the incidence of thromboembolism.Univariate analysis showed that CHADS₂ score and CHA₂DS₂-VASc score of risk factors,including chronic heart failure,hypertension,advanced age,diabetes and vascular disease,increased risk of thromboembolic disease.However,the impact of CHADS₂ score and CHA₂DS₂-VASc score on ischemic stroke in patients without atrial fibrillation is unclear.Objective:To evaluate the predictive value of CHADS₂ and CHA₂DS₂-VASc score ischemic stroke in patients without atrial fibrillation.Methods:This study collected from January 2014 to January 2016 in our hospital patients,all patients with history and electrocardiographic findings except for atrial fibrillation,all patients underwent brain CT or MRI examination,among them,826 patients with non AF stroke patients?stroke group?,randomly selected hospitalized in Department of Neurology in 1652 cases AF without stroke patients as non stroke group.Collect the patient's basic information,including patient age,gender,chronic heart failure has no history,no history of hypertension,history of diabetes mellitus,had no history of ischemic stroke and complications of vascular disease?including myocardial infarction,complex aortic atherosclerosis and peripheral atherosclerosis?,according to the the data of these patients were the two score here,new onset ischemic stroke without stroke risk score project.In order to compare the stroke group and non stroke group both CHADS₂ score and CHA₂DS₂-VASc score of these two items have no significant difference.Results:The stroke group compared with non stroke group,the risk factors contained in these two scores:age,gender,chronic heart failure,hypertension,diabetes,history of stroke/thromboembolism?TE?and vascular disease?including myocardial infarction,complexity of aortic atherosclerosis and peripheral atherosclerosis?and the difference between CHADS₂ score and CHA₂DS₂-VASc in this score in the two groups had statistical differences?P<0.05?.These risk factors Logistic regression analysis showed that CHADS₂ score?OR2.01,95%CI 1.64-2.48,P<0.001?,CHA₂DS₂-VASc score?OR1.37,95%CI 1.20-1.56 P<0.001?,hypertension?OR 4.94,95%CI 3.87-6.30 P<0.01?,vascular disease?OR 7.80,95%CI 5.53-11.02 P<0.01?.In conclusion,the CHADS₂ score,CHA₂DS₂-VASc score,hypertension and vascular disease are independent risk factors for stroke in patients with non atrial fibrillation.The CHADS₂ score and CHA₂DS₂-VASc score were visible ROC curve analysis results:CHADS₂ score threshold value were 0.5?sensitivity 83.7%,specificity of 60.6%,area under the curve of 0.769?;limit CHA₂DS₂-VASc score value of 1.5 points?sensitivity 80.1%,specificity of 62.8%,area under the curve of 0.764?.Conclusion?1?CHADS₂ score and CHA₂DS₂-VASc score are independent risk factors for stroke.the use of CHADS₂ and CHA₂DS₂-VASc score can predict the occurrence of ischemic stroke in patients without atrial fibrillation.?2?Hypertension and vascular disease are independent risk factors for ischemic stroke.?3?when the CHADS₂ score more than 1 points or CHA₂DS₂-VASc score more than 2 cent,the risk of ischemic stroke in patients without atrial fibrillation increased significantly.