The association between asymptomatic coronary artery disease and CHADS₂ and CHA₂DS₂-VASc scores in patients with stroke

Background and purpose: CHADS₂ and CHA₂DS₂-VASc scores are measurement tools that stratify thromboembolic risk in patients with non-valvular atrial fibrillation, and are predictive of cerebral atherosclerosis, fatal stroke and ischaemic heart disease. Patients with higher CHADS₂ and CHA₂DS₂-VASc scores are more likely to have had an akinetic/hypokinetic left ventricular segment or a recent myocardial infarction, all of which are associated with coronary artery disease (CAD). Most of the CHADS₂ score components are also risk factors for atherosclerosis. Thus, CHADS₂ and CHA₂DS₂-VASc scores may be predictive of CAD. Methods: In all, 1733 consecutive patients with acute ischaemic stroke who underwent multi-slice computed tomography coronary angiography were enrolled. The association of CHADS₂ and CHA₂DS₂-VASc scores with the presence and severity of CAD was investigated. Results: Of the 1733 patients, 1220 patients (70.4%) had any degree of CAD and 576 (33.3%) had significant CAD (≥50% stenosis in at least one coronary artery). As the CHADS₂ and CHA₂DS₂-VASc scores increased, the presence of CAD also increased (P < 0.001). The severity of CAD was correlated with CHADS₂ score (Spearman coefficient 0.229, P < 0.001) and CHA₂DS₂-VASc score (Spearman coefficient 0.261, P < 0.001). In multivariate analysis, after adjusting for confounding factors, CHADS₂ and CHA₂DS₂-VASc scores ≥2 were independently associated with CAD. The CHA₂DS₂-VASc score was a better predictor of the presence of CAD than the CHADS₂ score on area under the curve analysis. Conclusion: CHADS₂ and CHA₂DS₂-VASc scores were predictive of the presence and severity of CAD in patients with stroke. When a patient has high CHADS₂ or CHA₂DS₂-VASc scores, physicians should consider coronary artery evaluation.