Prediction of ischemic stroke by the CHA2DS2-VA score in an Asian population: A report from the prospective nationwide COOL-AF registry

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.