CHADS2 score is associated with 3-month clinical outcomes after intravenous rt-PA therapy in stroke patients with atrial fibrillation: SAMURAI rt-PA Registry

Purpose: The aim of this study was to examine whether CHADS(2) score is associated with clinical outcomes following recombinant tissue type plasminogen activator (rt-PA) therapy in stroke patients with atrial fibrillation (AF). Methods: We studied 218 consecutive stroke patients with AF [126 men, mean age 74.2 (SD 9.6) years] who received intravenous rt-PA therapy. CHADS(2) score was calculated as follows: 2 points for prior ischemic stroke and 1 point for each of the following: age >= 75 years, hypertension, diabetes, and congestive heart failure. Results: Congestive heart failure was documented in 23 patients, hypertension in 138, age 75 years in 116, diabetes in 35, and prior stroke in 35. The distribution of each CHADS(2) score was: score of 0,16.1% of patients; 1, 30.3%; 2,29.4%; and 3 to 5,24.3%. The median initial NIHSS score for each CHADS(2) category was 12 (IQR 8-17), 16(10-20), 14.5(10-20.75), and 16(11-21), respectively (p = 0.168). Symptomatic ICH within the initial 36 h was found in 2.9%, 4.6%, 6.3%, and 0% of patients with each CHADS(2) category, respectively. Cardiovascular events within 3 months occurred in 0%, 0%, 7.8% and 5.7%, respectively. Percentage of patients with chronic independence at 3 months corresponding to modified Rankin Scale <= 2 was 57.1%, 45.5%, 31.3%, and 28.3%, respectively. Adjusted CHADS(2) score was inversely associated with chronic independence (OR 0.72, 95% CI 0.55-0.93). Conclusion: Lower CHADS(2) score was associated with chronic independence at 3 months after intravenous rt-PA therapy in stroke patients with AF. (C) 2011 Elsevier B.V. All rights reserved.