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CC BY 4.0 · Arq Neuropsiquiatr 2023; 81(08): 712-719
DOI: 10.1055/s-0043-1771167
Original Article

Ischemic stroke risk factors not included in the CHADS-VASC score in patients with non-valvular atrial fibrillation

Fatores de risco de AVC isquêmico não incluídos no escore CHADS-VASC em pacientes com fibrilação atrial não valvar
Laurine Le Goff 
1   “Emile Muller” Hospital, Department of Cardiology, Mulhouse, France.
,
Stanislas Demuth 
2   Strasbourg University Hospital, Department of Neurology, France.
,
Andreas Fickl 
3   “Emile Muller” Hospital, Department of Neurology, Mulhouse, France.
,
Lucian Muresan 
1   “Emile Muller” Hospital, Department of Cardiology, Mulhouse, France.
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Abstract

Background In patients with atrial fibrillation, the CHA2DS2-VASC score guides stroke prevention using anticoagulants, but it is an imperfect score. Other potential risk factors such as renal failure, the type of atrial fibrillation, active smoking, cancer, sleep apnea or systemic inflammation have less well been investigated.

Objective To assess the impact of these factors on ischemic stroke risk in patients with non-valvular atrial fibrillation.

Methods On a population of 248 patients (124 patients with acute ischemic stroke and 124 controls), we performed a logistic regression to assess the impact of multiple non-classic risk factors for the prediction of acute ischemic stroke. Their impact on mortality was assessed by performing a survival analysis.

Results A high CHA2DS2-VASc score (OR 1.75; 95% CI 1.13–2.70; p = 0.032), treatment with anticoagulants (OR 0.19; 95% CI 0.07–0.51; p < 0.001) and permanent atrial fibrillation (OR 6.31; 95% CI 2.46–16.19; p < 0.001) were independently associated with acute ischemic stroke. Renal failure and chronic obstructive pulmonary disease predicted a higher mortality. After adjusting for age, sex, the CHA2DS2-VASc score and the use of anticoagulants, the only risk factor predictive for acute ischemic stroke was the permanent type of AF (OR: 8.0 [95% CI 2.5–25.5], p < 0.001).

Conclusions The CHA2DS2-VASc score, the absence of anticoagulants and the permanent type of atrial fibrillation were the main predictive factors for the occurrence of acute ischemic stroke. Larger studies are necessary for conclusive results about other factors.

Resumo

Antecedentes Em pacientes com fibrilação atrial, o escore CHA2DS2-VASC orienta a prevenção de AVC com anticoagulantes, mas é um escore imperfeito. Outros fatores de risco potenciais, como insuficiência renal, o tipo de fibrilação atrial, tabagismo ativo, câncer, apnéia do sono ou inflamação sistêmica foram menos bem investigados.

Objetivo Avaliar o impacto desses fatores no risco de AVC isquêmico em pacientes com fibrilação atrial não valvular.

Métodos Em uma população de 248 pacientes (124 pacientes com AVC isquêmico agudo e 124 controles), realizamos uma regressão logística para avaliar o impacto de múltiplos fatores de risco não clássicos na predição de AVC isquêmico agudo. O seu impacto na mortalidade foi avaliado através da realização de uma análise de sobrevivência.

Resultados Escore CHA2DS2-VASc alto (OR 1,75; IC 95% 1,13–2,70; p = 0,032), tratamento com anticoagulantes (OR 0,19; IC 95% 0,07–0,51; p < 0,001) e fibrilação atrial permanente (OR 6,31; 95% CI 2,46–16,19; p < 0,001) foram independentemente associados ao AVC isquêmico agudo. Insuficiência renal e doença pulmonar obstrutiva crônica previram maior mortalidade. Após ajuste para idade, sexo, pontuação CHA2DS2-VASc e uso de anticoagulantes, o único fator de risco preditivo para AVC isquêmico agudo foi o tipo permanente de FA (OR: 8,0 [IC 95% 2,5–25,5], p < 0,001).

Conclusões O escore CHA2DS2-VASc, a ausência de anticoagulantes e o tipo permanente de fibrilação atrial foram os principais fatores preditivos para a ocorrência de AVC isquêmico agudo. Estudos maiores são necessários para resultados conclusivos sobre outros fatores.

Keywords

Atrial Fibrillation - Stroke - Risk Factors - CHA2DS2-VASc

Palavras-chave

Fibrilação Atrial - Acidente Vascular Cerebral - Fatores de Risco - CHA2DS2-VASc

Authors' Contributions

LLG: conceptualization, data curation, formal analysis, investigation, methodology, writing – original draft; SD: conceptualization, formal analysis, investigation, methodology, writing – review & editing; AF: conceptualization, data curation, investigation, validation; LM: conceptualization, methodology, project administration, supervision, validation, visualization, writing – review & editing.




Publication History

Received: 03 December 2022

Accepted: 09 April 2023

Article published online:
11 August 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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