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.