Prediction of ischemic stroke by the CHA2DS2-VA score in an Asian population: A report from the prospective nationwide COOL-AF registry
Issued Date
2025-01-01
Resource Type
ISSN
15475271
eISSN
15563871
Scopus ID
2-s2.0-105007309418
Pubmed ID
40324512
Journal Title
Heart Rhythm
Rights Holder(s)
SCOPUS
Bibliographic Citation
Heart Rhythm (2025)
Suggested Citation
Krittayaphong R., Apiyasawat S., Methavigul K., Komoltri C., Lip G.Y.H. Prediction of ischemic stroke by the CHA2DS2-VA score in an Asian population: A report from the prospective nationwide COOL-AF registry. Heart Rhythm (2025). doi:10.1016/j.hrthm.2025.04.062 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/110680
Title
Prediction of ischemic stroke by the CHA2DS2-VA score in an Asian population: A report from the prospective nationwide COOL-AF registry
Corresponding Author(s)
Other Contributor(s)
Abstract
Background: The CHA<inf>2</inf>DS<inf>2</inf>-VA score, derived by the removal of women from the CHA<inf>2</inf>DS<inf>2</inf>-VASc score, has recently been recommended for the prediction of ischemic stroke/systemic embolism (SSE) in patients with atrial fibrillation (AF). Objective: Given the limited data in non-Western cohorts, the objective was to compare the performance of CHA<inf>2</inf>DS<inf>2</inf>-VASc and CHA<inf>2</inf>DS<inf>2</inf>-VA scores for the prediction of SSE in an Asian population. Methods: Patients with AF from the prospective multicenter Cohort of Antithrombotic Use and Optimal INR Level in Patients With Nonvalvular Atrial Fibrillation registry were studied. Patients were followed up every 6 months for 3 years. The primary outcome was SSE. C-statistics were used to compare the performance of CHA<inf>2</inf>DS<inf>2</inf>-VASc and CHA<inf>2</inf>DS<inf>2</inf>-VA scores for SSE risk prediction. The pattern of oral anticoagulant use is according to the practicing physicians. Results: A total of 3405 patients were studied (mean age 67.8 ± 11.3 years, 41.8% women). The incidence rate of SSE was 1.51 (1.26–1.78) per 100 person-years. The risk ratio for SSE for women was higher than men at CHA<inf>2</inf>DS<inf>2</inf>-VA scores ≥ 2 (1.72 [1.19–2.50], P = .004), similar for patients with and without oral anticoagulant use. The C-statistics for SSE was not statistically significantly different between CHA<inf>2</inf>DS<inf>2</inf>-VASc and CHA<inf>2</inf>DS<inf>2</inf>-VA scores (0.655 [0.639–0.671] and 0.647 [0.631–0.663], P = .258). Women had a greater risk of SSE than men at the age of > 70 years (P<inf>interaction</inf> = .007). Conclusion: Women with AF have an increased SSE risk compared with men with higher CHA<inf>2</inf>DS<inf>2</inf>-VA scores and at the age of > 70 years. The CHA<inf>2</inf>DS<inf>2</inf>-VA scores had a numerical but nonstatistically significant difference to CHA<inf>2</inf>DS<inf>2</inf>-VASc score for overall SSE risk prediction.