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Michał Mazurek, Gregory Y H Lip, CHA2DS2-VASc score risk factors as predictors of stroke after acute coronary syndrome: Can we really be sure there is no atrial fibrillation?, European Heart Journal. Acute Cardiovascular Care, Volume 7, Issue 3, 1 April 2018, Pages 275–277, https://doi.org/10.1177/2048872616688455
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The study
In this issue of European Heart Journal: Acute Cardiovascular Care, Guerra et al. present results of the systematic review and meta-analysis on over half a million of patients with recent acute coronary syndrome (ACS) that aimed to assess the value of the CHA2DS2-VASc scale (congestive heart failure, hypertension, age ⩾75 years, diabetes mellitus, stroke/transient ischaemic attack (TIA), vascular disease, age 65–74 years, sex category (female)) in stroke prediction, irrespective of atrial fibrillation (AF) history.1 The authors found that each component of the CHA2DS2-VASc strata was associated with a similarly increased risk of stroke/thromboembolism as previously reported in AF. Guerra et al. suggest that the predictive value of the CHA2DS2-VASc score is perhaps disconnected from AF, with AF being only one of the stroke risk factors, and that this scoring system may be validated in the ACS population to guide stroke prevention therapies.
The stroke/TIA rate is 1.3% in the present analysis (nine months median observation). This is not high, considering the fact that 11.2% of patients had AF previously diagnosed and the vast majority of patients must have had a high CHA2DS2-VASc score (although mean/median score was not provided). Unfortunately, no data on patients with stroke were provided, especially on what proportion actually had AF. Importantly, one in three patients with ischaemic stroke and over 80% of those with cardioembolic stroke may have had underlying AF.2 AF may also play a role in many cases (approximately a third) of cryptogenic strokes, which account for 25% of all strokes.
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