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Abstract
We investigated a multicenter registry to identify estimated event rates according to CHA2DS2-VASc scores in patients with acute ischemic stroke (AIS) and atrial fibrillation (AF). The additional effectiveness of antiplatelets (APs) plus oral anticoagulants (OACs) compared with OACs alone considering the CHA2DS2-VASc scores was also explored. This study retrospectively analyzed a multicenter stroke registry between Jan 2011 and Nov 2017, identifying patients with acute ischemic stroke with AF. The primary outcome event was a composite of recurrent stroke, myocardial infarction, and all-cause mortality within 1 year. A total of 7395 patients (age, 73 ± 10 years; men, 54.2%) were analyzed. The primary outcome events at one year ranged from 5.99% (95% CI 3.21–8.77) for a CHA2DS2-VASc score of 0 points to 30.45% (95% CI 24.93–35.97) for 7 or more points. After adjustments for covariates, 1-point increases in the CHA2DS2-VASc score consistently increased the risk of primary outcome events (aHR 1.10 [1.06–1.15]) at 1-year. Among OAC-treated patients at discharge (n = 5500), those treated with OAC + AP (vs. OAC alone) were more likely to experience vascular events, though among patients with a CHA2DS2-VASc score of 5 or higher, the risk of primary outcome in the OAC + AP group was comparable to that in the OAC alone group (Pint = 0.01). Our study found that there were significant associations of increasing CHA2DS2-VASc scores with the increasing risk of vascular events at 1-year in AIS with AF. Further study would be warranted.
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1 Chonnam National University Medical School, Chonnam National University Hospital, Department of Neurology, Gwangju, Korea
2 University of Ulsan College of Medicine, Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea (GRID:grid.267370.7) (ISNI:0000 0004 0533 4667)
3 Seoul National University Bundang Hospital, Department of Neurology, Cerebrovascular Center, Seoul National University College of Medicine, Seongnam-si, Korea (GRID:grid.412480.b) (ISNI:0000 0004 0647 3378)
4 Eulji University, Department of Neurology, Nowon Eulji Medical Center, Seoul, Korea (GRID:grid.255588.7) (ISNI:0000 0004 1798 4296)
5 Eulji University, Department of Neurology, Eulji University Hospital, Daejeon, Korea (GRID:grid.255588.7) (ISNI:0000 0004 1798 4296)
6 Dong-A University Hospital, Department of Neurology, Busan, Korea (GRID:grid.412048.b) (ISNI:0000 0004 0647 1081)
7 Seoul Medical Center, Department of Neurology, Seoul, Korea (GRID:grid.415520.7) (ISNI:0000 0004 0642 340X)
8 Soonchunhyang University Hospital, Department of Neurology, Seoul, Korea (GRID:grid.412678.e) (ISNI:0000 0004 0634 1623)
9 Yeungnam University Hospital, Department of Neurology, Daegu, Korea (GRID:grid.413040.2) (ISNI:0000 0004 0570 1914)
10 Inje University, Department of Neurology, Ilsan Paik Hospital, Goyang, Korea (GRID:grid.411612.1) (ISNI:0000 0004 0470 5112)
11 Hallym University Sacred Heart Hospital, Department of Neurology, Anyang, Korea (GRID:grid.488421.3) (ISNI:0000000404154154)
12 Dongguk University Ilsan Hospital, Department of Neurology, Goyang, Korea (GRID:grid.470090.a) (ISNI:0000 0004 1792 3864)
13 Jeju National University School of Medicine, Department of Neurology, Jeju National University Hospital, Jeju, Korea (GRID:grid.411277.6) (ISNI:0000 0001 0725 5207)
14 Ulsan University College of Medicine, Department of Neurology, Ulsan, Korea (GRID:grid.267370.7) (ISNI:0000 0004 0533 4667)
15 Chungbuk National University Hospital, Department of Neurology, Cheongju, Korea (GRID:grid.411725.4) (ISNI:0000 0004 1794 4809)
16 Keimyung University Dongsan Medical Center, Department of Neurology, Daegu, Korea (GRID:grid.414067.0) (ISNI:0000 0004 0647 8419)
17 Chonnam National University Medical School, Chonnam National University Hospital, Department of Neurology, Gwangju, Korea (GRID:grid.414067.0)
18 Korea University College of Medicine, Department of Biostatistics, Seoul, Korea (GRID:grid.222754.4) (ISNI:0000 0001 0840 2678)