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

PurposeThe aim of this study was to examine whether CHADS2 score is associated with clinical outcomes following recombinant tissue type plasminogen activator (rt-PA) therapy in stroke patients with atrial fibrillation (AF).MethodsWe studied 218 consecutive stroke patients with AF [126 men, mean age 74.2 (SD 9.6) years] who received intravenous rt-PA therapy. CHADS2 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.ResultsCongestive 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 CHADS2 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 CHADS2 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 CHADS2 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 CHADS2 score was inversely associated with chronic independence (OR 0.72, 95% CI 0.55–0.93).ConclusionLower CHADS2 score was associated with chronic independence at 3 months after intravenous rt-PA therapy in stroke patients with AF.