Associations between Pre-Admission Risk Scores and Two-Year Clinical Outcomes in Ischemic Stroke or Transient Ischemic Attack Patients with Non-Valvular Atrial Fibrillation

Keisuke Tokunaga, Hiroshi Yamagami, Masatoshi Koga, Kenichi Todo, Kazumi Kimura, Ryo Itabashi, Tadashi Terasaki, Yoshiaki Shiokawa, Kenji Kamiyama, Shunya Takizawa, Satoshi Okuda, Yasushi Okada, Tomoaki Kameda, Yoshinari Nagakane, Yasuhiro Hasegawa, Satoshi Shibuya, Yasuhiro Ito, Hideki Matsuoka, Kazuhiro Takamatsu, Kazutoshi NishiyamaKazuomi Kario, Yoshiki Yagita, Takanari Kitazono, Naoto Kinoshita, Junji Takasugi, Takuya Okata, Sohei Yoshimura, Shoichiro Sato, Shoji Arihiro, Kazunori Toyoda

Research output: Contribution to journalArticle

Abstract

Background: We aimed to clarify associations between pre-admission risk scores (CHADS 2 , CHA 2 DS 2 -VASc, and HAS-BLED) and 2-year clinical outcomes in ischemic stroke or transient ischemic attack (TIA) patients with non-valvular atrial fibrillation (NVAF) using a prospective, multicenter, observational registry. Methods: From 18 Japanese stroke centers, ischemic stroke or TIA patients with NVAF hospitalized within 7 days after onset were enrolled. Outcome measures were defined as death/disability (modified Rankin Scale score ≥3) at 2 years, 2-year mortality, and ischemic or hemorrhagic events within 2 years. Results: A total of 1,192 patients with NVAF (527 women; mean age, 78 ± 10 years), including 1,141 ischemic stroke and 51 TIA, were analyzed. Rates of death/disability, mortality, and ischemic or hemorrhagic events increased significantly with increasing pre-admission CHADS 2 (p for trend <0.001 for death/disability and mortality, p for trend = 0.024 for events), CHA 2 DS 2 -VASc (p for trend <0.001 for all), and HAS-BLED (p for trend = 0.004 for death/disability, p for trend <0.001 for mortality, p for trend = 0.024 for events) scores. Pre-admission CHADS 2 (OR per 1 point, 1.52; 95% CI 1.35-1.71; p <0.001 for death/disability; hazard ratio (HR) per 1 point, 1.23; 95% CI 1.12-1.35; p <0.001 for mortality; HR per 1 point, 1.14; 95% CI 1.02-1.26; p = 0.016 for events), CHA 2 DS 2 -VASc (1.55, 1.41-1.72, p < 0.001; 1.21, 1.12-1.30, p < 0.001; 1.17, 1.07-1.27, p < 0.001; respectively), and HAS-BLED (1.33, 1.17-1.52, p < 0.001; 1.23, 1.10-1.38, p < 0.001; 1.18, 1.05-1.34, p = 0.008; respectively) scores were independently associated with all outcome measures. Conclusions: In ischemic stroke or TIA patients with NVAF, all pre-admission risk scores were independently associated with death/disability at 2 years and 2-year mortality, as well as ischemic or hemorrhagic events within 2 years.

Original languageEnglish
Pages (from-to)170-179
Number of pages10
JournalCerebrovascular Diseases
Volume45
Issue number3-4
DOIs
Publication statusPublished - May 1 2018

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Transient Ischemic Attack
Atrial Fibrillation
Stroke
Mortality
Outcome Assessment (Health Care)
Registries

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Associations between Pre-Admission Risk Scores and Two-Year Clinical Outcomes in Ischemic Stroke or Transient Ischemic Attack Patients with Non-Valvular Atrial Fibrillation. / Tokunaga, Keisuke; Yamagami, Hiroshi; Koga, Masatoshi; Todo, Kenichi; Kimura, Kazumi; Itabashi, Ryo; Terasaki, Tadashi; Shiokawa, Yoshiaki; Kamiyama, Kenji; Takizawa, Shunya; Okuda, Satoshi; Okada, Yasushi; Kameda, Tomoaki; Nagakane, Yoshinari; Hasegawa, Yasuhiro; Shibuya, Satoshi; Ito, Yasuhiro; Matsuoka, Hideki; Takamatsu, Kazuhiro; Nishiyama, Kazutoshi; Kario, Kazuomi; Yagita, Yoshiki; Kitazono, Takanari; Kinoshita, Naoto; Takasugi, Junji; Okata, Takuya; Yoshimura, Sohei; Sato, Shoichiro; Arihiro, Shoji; Toyoda, Kazunori.

In: Cerebrovascular Diseases, Vol. 45, No. 3-4, 01.05.2018, p. 170-179.

Research output: Contribution to journalArticle

Tokunaga, K, Yamagami, H, Koga, M, Todo, K, Kimura, K, Itabashi, R, Terasaki, T, Shiokawa, Y, Kamiyama, K, Takizawa, S, Okuda, S, Okada, Y, Kameda, T, Nagakane, Y, Hasegawa, Y, Shibuya, S, Ito, Y, Matsuoka, H, Takamatsu, K, Nishiyama, K, Kario, K, Yagita, Y, Kitazono, T, Kinoshita, N, Takasugi, J, Okata, T, Yoshimura, S, Sato, S, Arihiro, S & Toyoda, K 2018, 'Associations between Pre-Admission Risk Scores and Two-Year Clinical Outcomes in Ischemic Stroke or Transient Ischemic Attack Patients with Non-Valvular Atrial Fibrillation', Cerebrovascular Diseases, vol. 45, no. 3-4, pp. 170-179. https://doi.org/10.1159/000487896
Tokunaga, Keisuke ; Yamagami, Hiroshi ; Koga, Masatoshi ; Todo, Kenichi ; Kimura, Kazumi ; Itabashi, Ryo ; Terasaki, Tadashi ; Shiokawa, Yoshiaki ; Kamiyama, Kenji ; Takizawa, Shunya ; Okuda, Satoshi ; Okada, Yasushi ; Kameda, Tomoaki ; Nagakane, Yoshinari ; Hasegawa, Yasuhiro ; Shibuya, Satoshi ; Ito, Yasuhiro ; Matsuoka, Hideki ; Takamatsu, Kazuhiro ; Nishiyama, Kazutoshi ; Kario, Kazuomi ; Yagita, Yoshiki ; Kitazono, Takanari ; Kinoshita, Naoto ; Takasugi, Junji ; Okata, Takuya ; Yoshimura, Sohei ; Sato, Shoichiro ; Arihiro, Shoji ; Toyoda, Kazunori. / Associations between Pre-Admission Risk Scores and Two-Year Clinical Outcomes in Ischemic Stroke or Transient Ischemic Attack Patients with Non-Valvular Atrial Fibrillation. In: Cerebrovascular Diseases. 2018 ; Vol. 45, No. 3-4. pp. 170-179.
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title = "Associations between Pre-Admission Risk Scores and Two-Year Clinical Outcomes in Ischemic Stroke or Transient Ischemic Attack Patients with Non-Valvular Atrial Fibrillation",
abstract = "Background: We aimed to clarify associations between pre-admission risk scores (CHADS 2 , CHA 2 DS 2 -VASc, and HAS-BLED) and 2-year clinical outcomes in ischemic stroke or transient ischemic attack (TIA) patients with non-valvular atrial fibrillation (NVAF) using a prospective, multicenter, observational registry. Methods: From 18 Japanese stroke centers, ischemic stroke or TIA patients with NVAF hospitalized within 7 days after onset were enrolled. Outcome measures were defined as death/disability (modified Rankin Scale score ≥3) at 2 years, 2-year mortality, and ischemic or hemorrhagic events within 2 years. Results: A total of 1,192 patients with NVAF (527 women; mean age, 78 ± 10 years), including 1,141 ischemic stroke and 51 TIA, were analyzed. Rates of death/disability, mortality, and ischemic or hemorrhagic events increased significantly with increasing pre-admission CHADS 2 (p for trend <0.001 for death/disability and mortality, p for trend = 0.024 for events), CHA 2 DS 2 -VASc (p for trend <0.001 for all), and HAS-BLED (p for trend = 0.004 for death/disability, p for trend <0.001 for mortality, p for trend = 0.024 for events) scores. Pre-admission CHADS 2 (OR per 1 point, 1.52; 95{\%} CI 1.35-1.71; p <0.001 for death/disability; hazard ratio (HR) per 1 point, 1.23; 95{\%} CI 1.12-1.35; p <0.001 for mortality; HR per 1 point, 1.14; 95{\%} CI 1.02-1.26; p = 0.016 for events), CHA 2 DS 2 -VASc (1.55, 1.41-1.72, p < 0.001; 1.21, 1.12-1.30, p < 0.001; 1.17, 1.07-1.27, p < 0.001; respectively), and HAS-BLED (1.33, 1.17-1.52, p < 0.001; 1.23, 1.10-1.38, p < 0.001; 1.18, 1.05-1.34, p = 0.008; respectively) scores were independently associated with all outcome measures. Conclusions: In ischemic stroke or TIA patients with NVAF, all pre-admission risk scores were independently associated with death/disability at 2 years and 2-year mortality, as well as ischemic or hemorrhagic events within 2 years.",
author = "Keisuke Tokunaga and Hiroshi Yamagami and Masatoshi Koga and Kenichi Todo and Kazumi Kimura and Ryo Itabashi and Tadashi Terasaki and Yoshiaki Shiokawa and Kenji Kamiyama and Shunya Takizawa and Satoshi Okuda and Yasushi Okada and Tomoaki Kameda and Yoshinari Nagakane and Yasuhiro Hasegawa and Satoshi Shibuya and Yasuhiro Ito and Hideki Matsuoka and Kazuhiro Takamatsu and Kazutoshi Nishiyama and Kazuomi Kario and Yoshiki Yagita and Takanari Kitazono and Naoto Kinoshita and Junji Takasugi and Takuya Okata and Sohei Yoshimura and Shoichiro Sato and Shoji Arihiro and Kazunori Toyoda",
year = "2018",
month = "5",
day = "1",
doi = "10.1159/000487896",
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pages = "170--179",
journal = "Cerebrovascular Diseases",
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TY - JOUR

T1 - Associations between Pre-Admission Risk Scores and Two-Year Clinical Outcomes in Ischemic Stroke or Transient Ischemic Attack Patients with Non-Valvular Atrial Fibrillation

AU - Tokunaga, Keisuke

AU - Yamagami, Hiroshi

AU - Koga, Masatoshi

AU - Todo, Kenichi

AU - Kimura, Kazumi

AU - Itabashi, Ryo

AU - Terasaki, Tadashi

AU - Shiokawa, Yoshiaki

AU - Kamiyama, Kenji

AU - Takizawa, Shunya

AU - Okuda, Satoshi

AU - Okada, Yasushi

AU - Kameda, Tomoaki

AU - Nagakane, Yoshinari

AU - Hasegawa, Yasuhiro

AU - Shibuya, Satoshi

AU - Ito, Yasuhiro

AU - Matsuoka, Hideki

AU - Takamatsu, Kazuhiro

AU - Nishiyama, Kazutoshi

AU - Kario, Kazuomi

AU - Yagita, Yoshiki

AU - Kitazono, Takanari

AU - Kinoshita, Naoto

AU - Takasugi, Junji

AU - Okata, Takuya

AU - Yoshimura, Sohei

AU - Sato, Shoichiro

AU - Arihiro, Shoji

AU - Toyoda, Kazunori

PY - 2018/5/1

Y1 - 2018/5/1

N2 - Background: We aimed to clarify associations between pre-admission risk scores (CHADS 2 , CHA 2 DS 2 -VASc, and HAS-BLED) and 2-year clinical outcomes in ischemic stroke or transient ischemic attack (TIA) patients with non-valvular atrial fibrillation (NVAF) using a prospective, multicenter, observational registry. Methods: From 18 Japanese stroke centers, ischemic stroke or TIA patients with NVAF hospitalized within 7 days after onset were enrolled. Outcome measures were defined as death/disability (modified Rankin Scale score ≥3) at 2 years, 2-year mortality, and ischemic or hemorrhagic events within 2 years. Results: A total of 1,192 patients with NVAF (527 women; mean age, 78 ± 10 years), including 1,141 ischemic stroke and 51 TIA, were analyzed. Rates of death/disability, mortality, and ischemic or hemorrhagic events increased significantly with increasing pre-admission CHADS 2 (p for trend <0.001 for death/disability and mortality, p for trend = 0.024 for events), CHA 2 DS 2 -VASc (p for trend <0.001 for all), and HAS-BLED (p for trend = 0.004 for death/disability, p for trend <0.001 for mortality, p for trend = 0.024 for events) scores. Pre-admission CHADS 2 (OR per 1 point, 1.52; 95% CI 1.35-1.71; p <0.001 for death/disability; hazard ratio (HR) per 1 point, 1.23; 95% CI 1.12-1.35; p <0.001 for mortality; HR per 1 point, 1.14; 95% CI 1.02-1.26; p = 0.016 for events), CHA 2 DS 2 -VASc (1.55, 1.41-1.72, p < 0.001; 1.21, 1.12-1.30, p < 0.001; 1.17, 1.07-1.27, p < 0.001; respectively), and HAS-BLED (1.33, 1.17-1.52, p < 0.001; 1.23, 1.10-1.38, p < 0.001; 1.18, 1.05-1.34, p = 0.008; respectively) scores were independently associated with all outcome measures. Conclusions: In ischemic stroke or TIA patients with NVAF, all pre-admission risk scores were independently associated with death/disability at 2 years and 2-year mortality, as well as ischemic or hemorrhagic events within 2 years.

AB - Background: We aimed to clarify associations between pre-admission risk scores (CHADS 2 , CHA 2 DS 2 -VASc, and HAS-BLED) and 2-year clinical outcomes in ischemic stroke or transient ischemic attack (TIA) patients with non-valvular atrial fibrillation (NVAF) using a prospective, multicenter, observational registry. Methods: From 18 Japanese stroke centers, ischemic stroke or TIA patients with NVAF hospitalized within 7 days after onset were enrolled. Outcome measures were defined as death/disability (modified Rankin Scale score ≥3) at 2 years, 2-year mortality, and ischemic or hemorrhagic events within 2 years. Results: A total of 1,192 patients with NVAF (527 women; mean age, 78 ± 10 years), including 1,141 ischemic stroke and 51 TIA, were analyzed. Rates of death/disability, mortality, and ischemic or hemorrhagic events increased significantly with increasing pre-admission CHADS 2 (p for trend <0.001 for death/disability and mortality, p for trend = 0.024 for events), CHA 2 DS 2 -VASc (p for trend <0.001 for all), and HAS-BLED (p for trend = 0.004 for death/disability, p for trend <0.001 for mortality, p for trend = 0.024 for events) scores. Pre-admission CHADS 2 (OR per 1 point, 1.52; 95% CI 1.35-1.71; p <0.001 for death/disability; hazard ratio (HR) per 1 point, 1.23; 95% CI 1.12-1.35; p <0.001 for mortality; HR per 1 point, 1.14; 95% CI 1.02-1.26; p = 0.016 for events), CHA 2 DS 2 -VASc (1.55, 1.41-1.72, p < 0.001; 1.21, 1.12-1.30, p < 0.001; 1.17, 1.07-1.27, p < 0.001; respectively), and HAS-BLED (1.33, 1.17-1.52, p < 0.001; 1.23, 1.10-1.38, p < 0.001; 1.18, 1.05-1.34, p = 0.008; respectively) scores were independently associated with all outcome measures. Conclusions: In ischemic stroke or TIA patients with NVAF, all pre-admission risk scores were independently associated with death/disability at 2 years and 2-year mortality, as well as ischemic or hemorrhagic events within 2 years.

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