Pre-Admission CHADS2and CHA2DS2-VASc Scores on Early Neurological Worsening

Ki Woong Nam, Chi Kyung Kim, Sungwook Yu, Jong Won Chung, Oh Young Bang, Gyeong Moon Kim, Jin Man Jung, Tae Jin Song, Yong Jae Kim, Bum Joon Kim, Sung Hyuk Heo, Kwang Yeol Park, Jeong Min Kim, Jong Ho Park, Jay Chol Choi, Man Seok Park, Joon Tae Kim, Kang Ho Choi, Yang Ha Hwang, Kyungmi OhWoo Keun Seo

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: Stroke risk scores (CHADS2 and CHA2DS2-VASc) not only predict the risk of stroke in atrial fibrillation (AF) patients, but have also been associated with prognosis after stroke. Objective: The aim of this study was to evaluate the relationship between stroke risk scores and early neurological deterioration (END) in ischemic stroke patients with AF. Methods: We included consecutive ischemic stroke patients with AF admitted between January 2013 and December 2015. CHADS2 and CHA2DS2-VASc scores were calculated using the established scoring system. END was defined as an increase ≥2 on the total National Institutes of Health Stroke Scale (NIHSS) score or ≥1 on the motor NIHSS score within the first 72 h of admission. Results: A total of 2,099 ischemic stroke patients with AF were included. In multivariable analysis, CHA2DS2-VASc score (adjusted odds ratio [aOR] = 1.17, 95% confidence interval [CI] = 1.04-1.31) was significantly associated with END after adjusting for confounders. Initial NIHSS score, use of anticoagulants, and intracranial atherosclerosis (ICAS) were also found to be closely associated with END, independent of the CHA2DS2-VASc score. Multivariable analysis stratified by the presence of ICAS demonstrated that both CHA2DS2-VASc (aOR = 1.20, 95% CI = 1.04-1.38) and CHADS2 scores (aOR = 1.24, 95% CI = 1.01-1.52) were closely related to END in only patients with ICAS. In patients without ICAS, neither of the risk scores were associated with END. Conclusions: High CHA2DS2-VASc score was associated with END in ischemic stroke patients with AF. This close relationship is more pronounced in patients with ICAS.

Original languageEnglish
Pages (from-to)288-295
Number of pages8
JournalCerebrovascular Diseases
Issue number3
StatePublished - May 2021

Bibliographical note

Funding Information:
The study was partially supported by the Korean Neurological Association (KNA-17-MI-10), Korea University Guro Hospital R&D Support Grant (O2001021) and the National Research Foundation of Korea (NRF-2019R1A2C2008788).

Publisher Copyright:
© 2021 S. Karger AG, Basel. Copyright: All rights reserved.


  • Atrial fibrillation
  • Cerebral atherosclerosis
  • Ischemic stroke
  • Prognosis
  • Risk scores


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