The association between asymptomatic coronary artery disease and CHADS2/CHA2DS2-VASC scores in patients with stroke

Abstract

Background: CHADS2 and CHA2DS2-VASc scores are measurement tools that

stratify thromboembolic risk in patients with nonvalvular atrial fibrillation, and

are predictive of cerebral atherosclerosis, fatal stroke, and ischaemic heart

disease. Patients with higher CHADS2/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 / CHA2DS2-VASc scores may be predictive of

CAD.

Methods: We enrolled 1733 consecutive patients with acute ischaemic stroke

who underwent multi-slice computed tomography coronary angiography. We

investigated the association of CHADS2 and CHA2DS2-VASc scores with the

presence and severity of CAD.

Results: Among 1733 patients, 1220 patients (70.4%) had any degree of 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 (Spearman coefficient 0.229, p<0.001) and CHA2DS2-VASc scores

(Spearman coefficient 0.261, p<0.001). In multivariate analysis, after adjusting

?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.

Conclusion: 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.