Clinical InvestigationCoronary Artery DiseaseThe CHADS2 score predicts ischemic stroke in the absence of atrial fibrillation among subjects with coronary heart disease: Data from the Heart and Soul Study
Section snippets
Participants
The Heart and Soul Study is a prospective cohort study designed to investigate psychosocial factors and health outcomes in patients with stable CHD. Details regarding recruitment methods and study design have been published previously.9 In brief, between September 2000 and December 2002, 1,024 outpatients with stable CHD were recruited from 2 Veterans Administration medical centers (Palo Alto and San Francisco), 1 university medical center (University of California, San Francisco), and 9
Results
Of the 916 nonanticoagulated participants with no evidence of baseline AF, the mean CHADS2 score was 1.7 ± 1.2. The CHADS2 score was strongly associated with each of the components used to derive the score (age, CHF, hypertension, diabetes, and stroke/TIA). Compared with participants with low CHADS2 scores (0-1), those with high CHADS2 scores (4-6) also had higher BMIs and were less likely to smoke. They were more likely to have a history of MI, lower left ventricular ejection fractions (LVEF),
Discussion
In 916 patients with CHD who had no known AF at baseline, we found that the CHADS2 score was strongly predictive of ischemic stroke/TIA. Compared with participants with low CHADS2 scores (0-1), those with intermediate CHADS2 scores (2-3) had an over 2-fold increased rate of stroke and those with high CHADS2 scores (4-6) had a 4-fold increased rate of stroke. The event rate in non-AF CHD patients with high CHADS2 scores (5-6) was comparable to the rate in AF patients with moderate CHADS2 scores
Conclusions
In summary, we found that the CHADS2 risk score independently predicts stroke/TIA in patients with CHD who have no known history of AF. The event rate in non-AF CHD patients with high CHADS2 scores (5-6) was comparable to published rates in AF patients with moderate CHADS2 scores (1-2). Because most strokes occur in patients without known AF, the CHADS2 score may have a role in identification of high-risk individuals who may benefit from stroke prevention therapies or screening for silent AF.
Disclosures
None.
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