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Perioperative stroke is associated with high mortality. We investigated the ability of the CHADS2 score to predict perioperative stroke in patients with and without atrial fibrillation (afib).
We analyzed data from the discharge weighted Nationwide Inpatient Sample(NIS) from 2001 to 2010. All patients undergoing major elective non-cardiac surgery requiring inpatient stay were selected using appropriate ICD-9-CM codes. Intracranial and carotid endarterectomy surgeries were excluded. Impact of previously known stroke risk factors, including afib and calculated CHADS2 score, were analyzed using logistic regression analysis with 95% CI(Confidence Intervals).
Of 25,275,327 patients 40,516(0.2%) had perioperative ischemic stroke. In patients with afib, 0.6% had stroke compared with 0.1% of those without afib. The highest unadjusted surgery specific risk factors were vascular(1.1%) and transplant(0.7%) surgery. Co-diagnosis of afib(adjusted odds ratio (OR) 2.47, 95% CI 2.39-2.55, p<0.001) and increasing CHADS2 score(OR 1.25, 95% CI 1.24-1.27, p<0.001) were independently associated with increased risk of stroke. CHADS2 score had higher predictive ability than individual elements of the score. Additional co-diagnoses associated with the highest OR of sustaining perioperative stroke were valvular heart disease and chronic kidney disease. Mortality in patients with stroke was 13% compared to 0.2% in those without stroke.
While atrial fibrillation predicts higher than normal risk of postoperative stroke, CHADS2 score continues to be relevant in predicting perioperative stroke risk in patients without atrial fibrillation. Preoperative CHADS2 score determination in patients without atrial fibrillation may be a useful tool in preoperative stroke risk assessment. CHADS2 score may also be useful in management of perioperative antiplatelet therapy.
Moderated Poster Contributions
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Atrial Fibrillation Mechanisms and Stroke Prevention
Abstract Category: 4. Arrhythmias: AF/SVT
Presentation Number: 1191M-49
- 2013 American College of Cardiology Foundation