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J Thorac Cardiovasc Surg. 2018 Jul 29. pii: S0022-5223(18)32030-0. doi: 10.1016/j.jtcvs.2018.06.096. [Epub ahead of print]

Performance of CHA2DS2-VASc score for stroke prediction after surgical aortic valve replacement.

Author information

1
Heart Center, Turku University Hospital and University of Turku, Turku, Finland. Electronic address: tuoski@utu.fi.
2
Heart Center, Turku University Hospital and University of Turku, Turku, Finland.
3
Heart Center, Kuopio University Hospital, Kuopio, Finland.
4
Department of Internal Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Internal Medicine, South Karelia Central Hospital, Lappeenranta, Finland.
5
Department of Surgery, Oulu University Hospital, Oulu, Finland.
6
Department of Internal Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
7
Heart Center, Satakunta Central Hospital, Pori, Finland.
8
Centre for Global Health, Italian Health Institute, Rome, Italy.
9
Heart Center, Turku University Hospital and University of Turku, Turku, Finland; Department of Surgery, Oulu University Hospital, Oulu, Finland.

Abstract

OBJECTIVE:

Stroke is a frequent complication occurring early and late after surgical aortic valve replacement. There is an unmet clinical need for simple tools to assess postoperative stroke risk. We sought to assess the predictive performance of Congestive heart failure; Hypertension; Age ≥75 (doubled); Diabetes mellitus; prior Stroke, transient ischemic attack or thromboembolism (doubled); Vascular disease; Age 65 to 74; Sex category (female) (CHA2DS2-VASc) score in patients undergoing surgical aortic valve replacement with a bioprosthesis.

METHODS:

Seven hundred fourteen patients undergoing isolated surgical aortic valve replacement with a bioprosthesis at 4 university hospitals were included. Data were collected retrospectively from patient records and monitored by an independent party.

RESULTS:

Median follow-up time was 4.8 years. Mean CHA2DS2-VASc score was 4.1 ± 1.6. Low (scores, 0-1), high (scores, 2-4), and very high (scores, 5-9) CHA2DS2-VASc scores were observed in 39 (5.5%), 400 (56.0%), and 262 (38.5%) patients, respectively. Incidences of stroke or transient ischemic attack at 1 year were 2.6%, 4.8%, and 10.7%; at 5 years incidences were 5.2%, 14.0%, and 21.9%; and at 10 years incidence were 5.2%, 20.7%, and 37.9% for patients in low, high, and very high scores, respectively. Incidences of major bleeds at 1 year were 0%, 1.8%, and 2.7%; at 5 years incidences were 0%, 5.4%, and 8.7%; and at 10 years incidences were 0%, 9.0%, and 27.1%, respectively. Competing risk analysis showed that patients with CHA2DS2-VASc score of 5 through 9 had a significantly increased risk of stroke or transient ischemic attack (hazard ratio, 4.75; 95% confidence interval, 1.09-20.6; P = .037) irrespective of preoperative or new-onset in-hospital atrial fibrillation compared with low-risk patients.

CONCLUSIONS:

CHA2DS2-VASc is a valuable tool to identify patients with increased risk of stroke and major bleeding, and for whom alternative strategies for prevention of late neurologic complications should be adopted.

KEYWORDS:

aortic valve replacement; cardiovascular surgery; ischemic stroke; transient ischemic attack

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