Original Paper Received: April 2, 2013 Accepted: June 11, 2013 Published online: October 16, 2013
Cerebrovasc Dis 2013;36:273–280 DOI: 10.1159/000353670
Pre-Stroke CHADS2 and CHA2DS2-VASc Scores Are Useful in Stratifying Three-Month Outcomes in Patients with and without Atrial Fibrillation Hans T.H. Tu a Bruce C.V. Campbell a Atte Meretoja a, b Leonid Churilov b Kennedy R. Lees c Geoffrey A. Donnan b Stephen M. Davis a on behalf of the VISTA collaborators
a University
Department of Medicine and Department of Neurology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Vic., b Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Vic., Australia; c Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
Key Words Stroke · CHADS2 score · CHA2DS2-VASc score · Atrial fibrillation · Outcome · Prognosis
Abstract Background: CHADS2 and CHA2DS2-VASc scores are validated tools for assessing stroke risk in patients with atrial fibrillation (AF). We investigated whether these scores are associated with 3-month stroke outcomes and evaluated the utility of these scores in stratifying 3-month stroke outcomes in both patients with and without AF. Methods: We analysed 6,612 acute ischaemic stroke patients from the Virtual International Stroke Trials Archive who received either placebo or ineffective active treatments not associated with significant cardiac complications. Outcomes included 3-month mortality, good functional outcomes defined as modified Rankin Scale score ≤1 and serious cardiac adverse events (SCAEs) defined as one of acute coronary syndrome, symptomatic heart failure, cardiopulmonary arrest, life-threatening arrhythmia and cardiac death. The association between the pre-stroke CHADS2 and CHA2DS2-VASc scores and 3-month stroke outcomes was assessed using binary logistic regression. The utility of the two scores in estimating 3-month stroke outcomes was assessed using area under the receiver operator characteristic curves (AUC) and com-
© 2013 S. Karger AG, Basel 1015–9770/13/0364–0273$38.00/0 E-Mail [email protected] www.karger.com/ced
pared using the χ2 test. Results: In this cohort, 26.5% had AF, 35.3% received IV tissue plasminogen activator (tPA), 17.7% died, 25.1% achieved good functional outcomes and 9.5% had ≥1 SCAE at 3 months. High-risk (≥2) pre-stroke CHADS2 and CHA2DS2-VASc scores are both associated with 3-month mortality (CHADS2: odds ratio, OR, 2.33, 95% confidence interval 1.81–3.00; CHA2DS2-VASc: OR 3.01, 2.00–4.80), good functional outcomes (CHADS2: OR 0.47, 0.39–0.57; CHA2DS2VASc: OR 0.55, 0.42–0.71) and SCAEs (CHADS2: OR 1.76, 1.28– 2.42; CHA2DS2-VASc: OR 2.69, 1.53–4.73) after adjusting for baseline differences in neurological impairment, tPA use and AF. The pre-stroke CHA2DS2-VASc score is better than the CHADS2 score in estimating 3-month stroke outcomes in both patients with and without AF (p ≤ 0.005 in all AUC comparisons). High-risk pre-stroke CHA2DS2-VASc score has high sensitivity for mortality (AF: 0.96, 0.94–0.98; no AF: 0.88, 0.86–0.91) and negative predictive value for SCAE (AF: 0.93, 0.87–0.96; no AF: 0.96, 0.95–0.97) within 3 months. Low risk pre-stroke CHA2DS2-VASc score has high specificity for good functional outcome (AF: 0.99, 0.98–0.994; no AF: 0.94, 0.93– 0.95) at 3 months. Conclusions: The pre-stroke CHA2DS2VASc score appears to be a simple tool for identifying patients at lower risk of poor outcomes and serious cardiac complications within 3 months following ischaemic stroke in patients with and without AF. © 2013 S. Karger AG, Basel
Stephen M. Davis Department of Neurology, The Royal Melbourne Hospital Grattan Street Parkville, VIC 3050 (Australia) E-Mail Stephen.Davis @ mh.org.au
Introduction
The CHADS2 (one point each for Congestive heart failure, Hypertension, Age ≥75 years, Diabetes and two points for previous Stroke or transient ischaemic attack, TIA) score is a well-validated and clinically useful tool for assessing the risk of ischaemic stroke in patients with atrial fibrillation (AF) [1]. The CHA2DS2-VASc (Congestive heart failure, Hypertension, Age ≥75 years, Diabetes, previous Stroke or TIA, Vascular disease, Age 65–74 years, Sex category) score is a validated score that complements the CHADS2 score by improving stroke risk stratification in patients with a low CHADS2 score [2, 3]. Many components of the CHADS2 and CHA2DS2VASc scores are also associated with worse stroke outcomes in both patients with and without AF [4]. Recent studies have shown that the pre-stroke CHADS2 score is associated with neurological outcomes at one week, functional outcomes at 3 months, and long-term fatal ischaemic heart disease following ischaemic stroke in patients with AF [5–7]. An association between the pre-stroke CHADS2 score and long-term mortality following stroke in both patients with and without AF has also been reported [8]. Additionally, the pre-stroke CHADS2 and CHA2DS2-VASc scores have both been linked to longterm mortality, stroke recurrence and cardiovascular events in ischaemic stroke patients without AF [9]. However, previous studies have not evaluated or compared the clinical utility of these scores in estimating the outcomes in patients with ischaemic stroke. We therefore hypothesized that the pre-stroke CHADS2 and CHA2DS2-VASc scores would be independently associated with 3-month functional outcome, mortality and serious cardiac adverse events (SCAEs) following ischaemic stroke in both patients with and without AF. We tested our hypothesis and evaluated the utility of the pre-stroke CHADS2 and CHA2DS2-VASc scores in estimating 3-month ischaemic stroke outcomes using the clinical data from a select sample of acute ischaemic stroke patients from the Virtual International Stroke Trials Archive (VISTA).
Methods The objectives, content and governance of VISTA have previously been described in detail [10, 11]. In brief, VISTA is an international collaborative repository that holds stroke clinical trial data from acute stroke, rehabilitation, secondary prevention and observational studies. These data are collated in a standardized format and accessible in an anonymized form for novel explor-
274
Cerebrovasc Dis 2013;36:273–280 DOI: 10.1159/000353670
atory analyses. Every acute stroke trial within VISTA has a minimum of 100 patients, documented entry criteria, documented consent or waiver of consent approved by a local institutional review board, baseline assessment using a validated neurological impairment scale within 24 h of stroke onset, confirmation of stroke diagnosis by cerebral imaging within 7 days, outcome assessment using a validated neurological or functional impairment scale between 1 and 6 months after stroke onset, and documented monitoring procedures to validate data. For this study, we collated anonymous patient data from acute ischaemic stroke trials in VISTA that documented age, gender, treatment with IV tissue plasminogen activator (tPA), pre-stroke history of congestive heart failure, hypertension, diabetes, stroke, TIA, myocardial infarction (MI), and AF, baseline National Institutes of Health Stroke Scale (NIHSS) score, 3-month modified Rankin Scale (mRS) score, mortality and cardiac complications within the first 3 months. We included data from patients who received placebo investigative treatment in the source trials. Data from patients who received active investigative treatments from source trials that reported no significant effect on stroke outcome or cardiac complications such as angina, MI, heart failure or arrhythmias were also included. Of the 28,190 acute ischaemic stroke patients in VISTA, 6,612 patients met our selection criteria. Compared to the published baseline and outcome variables for the entire cohort of acute ischaemic stroke patients in VISTA, the baseline NIHSS score was slightly higher (median 13 vs. 11), the proportion of patients with history of AF was lower (26.5 vs. 31.1%) and hypertension was higher (73.5 vs. 68.6%) amongst the patients that met our selection criteria [11]. Age (72 vs. 71 years), gender (female 45.8 vs. 45.1%), proportion of patients with history of MI (13.8 vs. 14.8%) and diabetes (23.1 vs. 22.3%), 90-day mRS score (median 3 vs. 3) and mortality (17.7 vs. 15.6%) were similar. A quantitative comparison with the entire VISTA cohort could not be performed, as approval for analysis was limited to patients who met our selection criteria. The pre-stroke CHADS2 and CHA2DS2-VASc scores for each patient were calculated from the collated baseline data. As the source trials were anonymized, the precise definition for congestive heart failure, hypertension, diabetes, stroke, TIA, MI and AF could not be determined. Data for peripheral artery disease that comprise part of the vascular disease component of the CHA2DS2VASc score were also not available. However, the proportion of acute ischaemic stroke patients with peripheral artery disease in the absence of ischaemic heart disease is likely to be small [12]. The outcome variables include 3-month all-cause mortality, good functional outcomes, defined as mRS ≤1 at 3 months, and SCAEs, encompassing any episode of acute coronary syndrome (comprising unstable angina and acute MI), symptomatic heart failure, life-threatening arrhythmia (including asystole, sick sinus syndrome, ventricular tachycardia and ventricular fibrillation), cardiopulmonary arrest and cardiac death within the first 3 months [13]. Patients were classified into subgroups according to their AF status and the pre-stroke CHADS2 and CHA2DS2-VASc scores. The commonly used low (0), intermediate (1) and high (≥2) risk categorisation and the raw CHADS2 (0–6) and CHA2DS2-VASc (0–9) scores were evaluated [3]. For univariable analyses, all continuous data were described as median with interquartile range and analysed using the Mann-Whitney U test due to the nature of
Tu et al.
the underlying distributions. Categorical and dichotomized variables were described as percentages and analysed using Fisher’s exact test for variables with only two categories and the χ2 test for variables with more than two categories. Binary logistic regression modelling was used to test the association of the pre-stroke CHADS2 and CHA2DS2-VASc scores with 3-month mortality, good functional outcomes and SCAEs, adjusting for other known baseline predictors including neurological impairment, tPA use and AF [13–15]. The utility of the raw pre-stroke CHADS2 and CHA2DS2-VASc scores in estimating 3-month mortality, good functional outcomes and SCAEs was assessed using the area under the receiver operator characteristic curves (AUC) and compared using the χ2 test. The sensitivity, specificity, positive and negative predictive values of high risk prestroke CHADS2 and CHA2DS2-VASc scores for 3-month mortality and SCAEs, and that of low risk scores for 3-month good functional outcomes were calculated to further evaluate the clinical utility of both scores. All statistical analyses were performed using SPSS (v20, IBM Corp. Armonk, N.Y., USA) and STATA (v12, StataCorp, College Station, Tex., USA).
Results
In this cohort of 6,612 acute ischaemic stroke patients presenting within 24 h of stroke onset, 2,334 (35.3%) received IV tPA and 1,755 (26.5%) had AF. At baseline, patients with AF were older, a higher proportion were female, had greater neurological impairment and were treated with IV tPA less frequently compared to patients without AF (table 1). Baseline history of congestive heart failure, hypertension, stroke and TIA were reported more and diabetes less frequently in patients with AF. The majority of patients had intermediate and high-risk prestroke CHADS2 scores. An even greater proportion of patients had intermediate and high-risk pre-stroke CHA2DS2-VASc scores. Compared to those without AF, a higher proportion of patients with AF had intermediate and high-risk pre-stroke CHADS2 and CHA2DS2-VASc scores. Only one patient had a pre-stroke CHA2DS2VASc score above 7. Patients with AF had a higher mortality rate and worse functional outcomes at 3 months compared to patients without AF (table 1). A total of 629 patients (9.5%) had at least one SCAE in the first 90 days after stroke. Overall, 64.7% of the first SCAEs occurred within the first 7 (AF 65.8 vs. no AF 64%, p = 0.7) and 74.7% (AF 76.1 vs. no AF 73.8%, p = 0.6) within the first 14 days of stroke. SCAEs occurred more frequently in patients with AF, particularly symptomatic heart failure (7.7 vs. 3.0%, p < 0.001) and life-threatening cardiac arrhythmia (2.5 vs. 1.4%, p = 0.003). CHADS2, CHA2DS2-VASc and Three-Month Stroke Outcomes
Table 1. Baseline characteristics and 3-month outcomes
AF No AF p (n = 1,755) (n = 4,857) Baseline characteristics Age, years Median IQR Female, % Baseline NIHSS Median IQR IV tPA use, % Congestive heart failure, % Hypertension, % Diabetes, % History of TIA or stroke, % History of MI, % CHADS2 score, % 0 1 ≥2 CHA2DS2-VASc score, % 0 1 ≥2 Three-month outcomes All-cause mortality, % mRS Median IQR SCAE, %
76 69–81 53.0
70 59–77 43.1
Cerebrovasc Dis 2013;36:273–280 DOI: 10.1159/000353670
Pre-Stroke CHADS2 and CHA2DS2-VASc Scores Are Useful in Stratifying Three-Month Outcomes in Patients with and without Atrial Fibrillation Hans T.H. Tu a Bruce C.V. Campbell a Atte Meretoja a, b Leonid Churilov b Kennedy R. Lees c Geoffrey A. Donnan b Stephen M. Davis a on behalf of the VISTA collaborators
a University
Department of Medicine and Department of Neurology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Vic., b Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Vic., Australia; c Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
Key Words Stroke · CHADS2 score · CHA2DS2-VASc score · Atrial fibrillation · Outcome · Prognosis
Abstract Background: CHADS2 and CHA2DS2-VASc scores are validated tools for assessing stroke risk in patients with atrial fibrillation (AF). We investigated whether these scores are associated with 3-month stroke outcomes and evaluated the utility of these scores in stratifying 3-month stroke outcomes in both patients with and without AF. Methods: We analysed 6,612 acute ischaemic stroke patients from the Virtual International Stroke Trials Archive who received either placebo or ineffective active treatments not associated with significant cardiac complications. Outcomes included 3-month mortality, good functional outcomes defined as modified Rankin Scale score ≤1 and serious cardiac adverse events (SCAEs) defined as one of acute coronary syndrome, symptomatic heart failure, cardiopulmonary arrest, life-threatening arrhythmia and cardiac death. The association between the pre-stroke CHADS2 and CHA2DS2-VASc scores and 3-month stroke outcomes was assessed using binary logistic regression. The utility of the two scores in estimating 3-month stroke outcomes was assessed using area under the receiver operator characteristic curves (AUC) and com-
© 2013 S. Karger AG, Basel 1015–9770/13/0364–0273$38.00/0 E-Mail [email protected] www.karger.com/ced
pared using the χ2 test. Results: In this cohort, 26.5% had AF, 35.3% received IV tissue plasminogen activator (tPA), 17.7% died, 25.1% achieved good functional outcomes and 9.5% had ≥1 SCAE at 3 months. High-risk (≥2) pre-stroke CHADS2 and CHA2DS2-VASc scores are both associated with 3-month mortality (CHADS2: odds ratio, OR, 2.33, 95% confidence interval 1.81–3.00; CHA2DS2-VASc: OR 3.01, 2.00–4.80), good functional outcomes (CHADS2: OR 0.47, 0.39–0.57; CHA2DS2VASc: OR 0.55, 0.42–0.71) and SCAEs (CHADS2: OR 1.76, 1.28– 2.42; CHA2DS2-VASc: OR 2.69, 1.53–4.73) after adjusting for baseline differences in neurological impairment, tPA use and AF. The pre-stroke CHA2DS2-VASc score is better than the CHADS2 score in estimating 3-month stroke outcomes in both patients with and without AF (p ≤ 0.005 in all AUC comparisons). High-risk pre-stroke CHA2DS2-VASc score has high sensitivity for mortality (AF: 0.96, 0.94–0.98; no AF: 0.88, 0.86–0.91) and negative predictive value for SCAE (AF: 0.93, 0.87–0.96; no AF: 0.96, 0.95–0.97) within 3 months. Low risk pre-stroke CHA2DS2-VASc score has high specificity for good functional outcome (AF: 0.99, 0.98–0.994; no AF: 0.94, 0.93– 0.95) at 3 months. Conclusions: The pre-stroke CHA2DS2VASc score appears to be a simple tool for identifying patients at lower risk of poor outcomes and serious cardiac complications within 3 months following ischaemic stroke in patients with and without AF. © 2013 S. Karger AG, Basel
Stephen M. Davis Department of Neurology, The Royal Melbourne Hospital Grattan Street Parkville, VIC 3050 (Australia) E-Mail Stephen.Davis @ mh.org.au
Introduction
The CHADS2 (one point each for Congestive heart failure, Hypertension, Age ≥75 years, Diabetes and two points for previous Stroke or transient ischaemic attack, TIA) score is a well-validated and clinically useful tool for assessing the risk of ischaemic stroke in patients with atrial fibrillation (AF) [1]. The CHA2DS2-VASc (Congestive heart failure, Hypertension, Age ≥75 years, Diabetes, previous Stroke or TIA, Vascular disease, Age 65–74 years, Sex category) score is a validated score that complements the CHADS2 score by improving stroke risk stratification in patients with a low CHADS2 score [2, 3]. Many components of the CHADS2 and CHA2DS2VASc scores are also associated with worse stroke outcomes in both patients with and without AF [4]. Recent studies have shown that the pre-stroke CHADS2 score is associated with neurological outcomes at one week, functional outcomes at 3 months, and long-term fatal ischaemic heart disease following ischaemic stroke in patients with AF [5–7]. An association between the pre-stroke CHADS2 score and long-term mortality following stroke in both patients with and without AF has also been reported [8]. Additionally, the pre-stroke CHADS2 and CHA2DS2-VASc scores have both been linked to longterm mortality, stroke recurrence and cardiovascular events in ischaemic stroke patients without AF [9]. However, previous studies have not evaluated or compared the clinical utility of these scores in estimating the outcomes in patients with ischaemic stroke. We therefore hypothesized that the pre-stroke CHADS2 and CHA2DS2-VASc scores would be independently associated with 3-month functional outcome, mortality and serious cardiac adverse events (SCAEs) following ischaemic stroke in both patients with and without AF. We tested our hypothesis and evaluated the utility of the pre-stroke CHADS2 and CHA2DS2-VASc scores in estimating 3-month ischaemic stroke outcomes using the clinical data from a select sample of acute ischaemic stroke patients from the Virtual International Stroke Trials Archive (VISTA).
Methods The objectives, content and governance of VISTA have previously been described in detail [10, 11]. In brief, VISTA is an international collaborative repository that holds stroke clinical trial data from acute stroke, rehabilitation, secondary prevention and observational studies. These data are collated in a standardized format and accessible in an anonymized form for novel explor-
274
Cerebrovasc Dis 2013;36:273–280 DOI: 10.1159/000353670
atory analyses. Every acute stroke trial within VISTA has a minimum of 100 patients, documented entry criteria, documented consent or waiver of consent approved by a local institutional review board, baseline assessment using a validated neurological impairment scale within 24 h of stroke onset, confirmation of stroke diagnosis by cerebral imaging within 7 days, outcome assessment using a validated neurological or functional impairment scale between 1 and 6 months after stroke onset, and documented monitoring procedures to validate data. For this study, we collated anonymous patient data from acute ischaemic stroke trials in VISTA that documented age, gender, treatment with IV tissue plasminogen activator (tPA), pre-stroke history of congestive heart failure, hypertension, diabetes, stroke, TIA, myocardial infarction (MI), and AF, baseline National Institutes of Health Stroke Scale (NIHSS) score, 3-month modified Rankin Scale (mRS) score, mortality and cardiac complications within the first 3 months. We included data from patients who received placebo investigative treatment in the source trials. Data from patients who received active investigative treatments from source trials that reported no significant effect on stroke outcome or cardiac complications such as angina, MI, heart failure or arrhythmias were also included. Of the 28,190 acute ischaemic stroke patients in VISTA, 6,612 patients met our selection criteria. Compared to the published baseline and outcome variables for the entire cohort of acute ischaemic stroke patients in VISTA, the baseline NIHSS score was slightly higher (median 13 vs. 11), the proportion of patients with history of AF was lower (26.5 vs. 31.1%) and hypertension was higher (73.5 vs. 68.6%) amongst the patients that met our selection criteria [11]. Age (72 vs. 71 years), gender (female 45.8 vs. 45.1%), proportion of patients with history of MI (13.8 vs. 14.8%) and diabetes (23.1 vs. 22.3%), 90-day mRS score (median 3 vs. 3) and mortality (17.7 vs. 15.6%) were similar. A quantitative comparison with the entire VISTA cohort could not be performed, as approval for analysis was limited to patients who met our selection criteria. The pre-stroke CHADS2 and CHA2DS2-VASc scores for each patient were calculated from the collated baseline data. As the source trials were anonymized, the precise definition for congestive heart failure, hypertension, diabetes, stroke, TIA, MI and AF could not be determined. Data for peripheral artery disease that comprise part of the vascular disease component of the CHA2DS2VASc score were also not available. However, the proportion of acute ischaemic stroke patients with peripheral artery disease in the absence of ischaemic heart disease is likely to be small [12]. The outcome variables include 3-month all-cause mortality, good functional outcomes, defined as mRS ≤1 at 3 months, and SCAEs, encompassing any episode of acute coronary syndrome (comprising unstable angina and acute MI), symptomatic heart failure, life-threatening arrhythmia (including asystole, sick sinus syndrome, ventricular tachycardia and ventricular fibrillation), cardiopulmonary arrest and cardiac death within the first 3 months [13]. Patients were classified into subgroups according to their AF status and the pre-stroke CHADS2 and CHA2DS2-VASc scores. The commonly used low (0), intermediate (1) and high (≥2) risk categorisation and the raw CHADS2 (0–6) and CHA2DS2-VASc (0–9) scores were evaluated [3]. For univariable analyses, all continuous data were described as median with interquartile range and analysed using the Mann-Whitney U test due to the nature of
Tu et al.
the underlying distributions. Categorical and dichotomized variables were described as percentages and analysed using Fisher’s exact test for variables with only two categories and the χ2 test for variables with more than two categories. Binary logistic regression modelling was used to test the association of the pre-stroke CHADS2 and CHA2DS2-VASc scores with 3-month mortality, good functional outcomes and SCAEs, adjusting for other known baseline predictors including neurological impairment, tPA use and AF [13–15]. The utility of the raw pre-stroke CHADS2 and CHA2DS2-VASc scores in estimating 3-month mortality, good functional outcomes and SCAEs was assessed using the area under the receiver operator characteristic curves (AUC) and compared using the χ2 test. The sensitivity, specificity, positive and negative predictive values of high risk prestroke CHADS2 and CHA2DS2-VASc scores for 3-month mortality and SCAEs, and that of low risk scores for 3-month good functional outcomes were calculated to further evaluate the clinical utility of both scores. All statistical analyses were performed using SPSS (v20, IBM Corp. Armonk, N.Y., USA) and STATA (v12, StataCorp, College Station, Tex., USA).
Results
In this cohort of 6,612 acute ischaemic stroke patients presenting within 24 h of stroke onset, 2,334 (35.3%) received IV tPA and 1,755 (26.5%) had AF. At baseline, patients with AF were older, a higher proportion were female, had greater neurological impairment and were treated with IV tPA less frequently compared to patients without AF (table 1). Baseline history of congestive heart failure, hypertension, stroke and TIA were reported more and diabetes less frequently in patients with AF. The majority of patients had intermediate and high-risk prestroke CHADS2 scores. An even greater proportion of patients had intermediate and high-risk pre-stroke CHA2DS2-VASc scores. Compared to those without AF, a higher proportion of patients with AF had intermediate and high-risk pre-stroke CHADS2 and CHA2DS2-VASc scores. Only one patient had a pre-stroke CHA2DS2VASc score above 7. Patients with AF had a higher mortality rate and worse functional outcomes at 3 months compared to patients without AF (table 1). A total of 629 patients (9.5%) had at least one SCAE in the first 90 days after stroke. Overall, 64.7% of the first SCAEs occurred within the first 7 (AF 65.8 vs. no AF 64%, p = 0.7) and 74.7% (AF 76.1 vs. no AF 73.8%, p = 0.6) within the first 14 days of stroke. SCAEs occurred more frequently in patients with AF, particularly symptomatic heart failure (7.7 vs. 3.0%, p < 0.001) and life-threatening cardiac arrhythmia (2.5 vs. 1.4%, p = 0.003). CHADS2, CHA2DS2-VASc and Three-Month Stroke Outcomes
Table 1. Baseline characteristics and 3-month outcomes
AF No AF p (n = 1,755) (n = 4,857) Baseline characteristics Age, years Median IQR Female, % Baseline NIHSS Median IQR IV tPA use, % Congestive heart failure, % Hypertension, % Diabetes, % History of TIA or stroke, % History of MI, % CHADS2 score, % 0 1 ≥2 CHA2DS2-VASc score, % 0 1 ≥2 Three-month outcomes All-cause mortality, % mRS Median IQR SCAE, %
76 69–81 53.0
70 59–77 43.1
