Background and purpose
CHADS2 and CHA2DS2-VASc scores are measurement tools that stratify thromboembolic risk in patients with non-valvular atrial fibrillation, and are predictive of cerebral atherosclerosis, fatal stroke and ischaemic heart disease. Patients with higher CHADS2 and CHA2DS2-VASc scores are more likely to have had an akinetic/hypokinetic left ventricular segment or a recent myocardial infarction, all of which are associated with coronary artery disease (CAD). Most of the CHADS2 score components are also risk factors for atherosclerosis. Thus, CHADS2 and CHA2DS2-VASc scores may be predictive of CAD.
In all, 1733 consecutive patients with acute ischaemic stroke who underwent multi-slice computed tomography coronary angiography were enrolled. The association of CHADS2 and CHA2DS2-VASc scores with the presence and severity of CAD was investigated.
Of the 1733 patients, 1220 patients (70.4%) had any degree of CAD and 576 (33.3%) had significant CAD (≥50% stenosis in at least one coronary artery). As the CHADS2 and CHA2DS2-VASc scores increased, the presence of CAD also increased (P < 0.001). The severity of CAD was correlated with CHADS2 score (Spearman coefficient 0.229, P < 0.001) and CHA2DS2-VASc score (Spearman coefficient 0.261, P < 0.001). In multivariate analysis, after adjusting for confounding factors, CHADS2 and CHA2DS2-VASc scores ≥2 were independently associated with CAD. The CHA2DS2-VASc score was a better predictor of the presence of CAD than the CHADS2 score on area under the curve analysis.
CHADS2 and CHA2DS2-VASc scores were predictive of the presence and severity of CAD in patients with stroke. When a patient has high CHADS2 or CHA2DS2-VASc scores, physicians should consider coronary artery evaluation.