3 years ago

Usefulness of CHADS2 and CHA2DS2-VASc Scores for Stroke Prediction in Patients With Cancer and Atrial Fibrillation

Stroke prediction scores have not been validated in patients with cancer and Atrial Fibrillation (AF). We aimed to identify unique risk factors and evaluate validity of CHADS2 and CHA2DS2-VASc scores to predict risk of stroke and mortality. A retrospective review of all cancer patients with pre-existing AF presenting from 2008 to 2014 was performed. Outcomes included ischemic stroke and mortality. Prognostic factors were identified with Fine & Gray regression for stroke and Cox proportional hazards analysis for survival. After excluding patients with hemorrhagic strokes (n=15) 2,037 patients were analyzed. Genitourinary cancers were the most common (29%) followed by gastrointestinal (GI) (18%). Overall, 52% had CHADS2 ≥ 2, 68% had hypertension and 35% had vascular disease. At a median of 6.4 months (0,93) 74 patients (3.6%) developed an ischemic stroke. Increased CHADS2 score was associated with stroke (HR 1.41; 95% CI 1.19-1.67; p <0.001), stronger than CHA2DS2-VASc (HR 1.26; 95% CI 1.11-1.43; p <0.001). Other significant factors included primary cancer site (hematologic, GI and skin [HR 2.69; 95% CI 1.29-5.59; p=0.008]) and antiplatelet therapy (HR 1.94; 95% CI 1.23-3.07; p=0.004). In multivariable analysis CHADS2 score was associated with mortality (HR 1.24; 95% CI 1.17-1.32; p <0.001) and occurrence of stroke (HR 3.26; 95% CI 2.27-4.67; p <0.001). In conclusion, in patients with cancer and AF, each point increase in CHADS2 is associated with nearly 40% greater risk of stroke. Increasing CHADS2 and CHA2DS2-VASc scores are associated with worsened survival. Hematologic, gastrointestinal and skin cancers are associated with a higher risk of stroke.

Publisher URL: www.sciencedirect.com/science

DOI: S0002914917314571

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