Risk Factors of Stroke in Patients with Nonvalvular Chronic Atrial Fibrillation: From View of CHADS2 and CHA2DS2-VASc

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Background and Aims: CHADS2 is a risk stratification score for stroke in patients with nonvalvular atrial fibrillation (NVAF). Prevention for the stroke and thromboembolism at low risk group of CHADS2 is discussed recently. To predict these cases, CHA2DS2-VASc is a useful score also. We assessed the usefulness of CHA2DS2-VASc in Japanese, compared with conventional CHADS2 which has evidence for Japanese. Methods: One hundred and seventy-nine patients with NVAF, who recorded Holter monitoring between January 1st 1990 and December 31st 1996, were enrolled in this study. The relationship of CHADS2 or CHA2DS2-VASc with the end point of stroke was investigated. We classified risk grade (low=0, moderate=1 or 2, and high risk=more than 3) to stratify clinical risks. Results: CHA2DS2-VASc decreased the number of 0 point patient and there incidence rate (CHADS2=23.5%; 0.011 person-year, CHA2DS2-VASc=11.2%; 0.005 person-year). Additionally, prognosis of 0 point group vs. 1 point group with end point of stroke have well differentiated (Log lank P=0.06). CHA2DS2-VASc could stratify the risk group in over 10 years from Holter recordings (p=0.05, low vs. moderate; p=0.03, moderate vs. high risk). Conclusion: CHA2DS2-VASc could stratify risk of stroke in Japanese patients with NVAF. To find out the low risk patient for stroke, CHA2DS2-VASc is more sensitive than CHADS2.