Supplementary Material for: Pre-Stroke CHADS<sub>2</sub> and CHA<sub>2</sub>DS<sub>2</sub>-VASc Scores Are Useful in Stratifying Three-Month Outcomes in Patients with and without Atrial Fibrillation
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<b><i>Background:</i></b> CHADS<sub>2</sub> and CHA<sub>2</sub>DS<sub>2</sub>-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. <b><i>Methods:</i></b> 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 CHADS<sub>2</sub> and CHA<sub>2</sub>DS<sub>2</sub>-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 compared using the χ<sup>2</sup> test. <b><i>Results:</i></b> 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 CHADS<sub>2</sub> and CHA<sub>2</sub>DS<sub>2</sub>-VASc scores are both associated with 3-month mortality (CHADS<sub>2</sub>: odds ratio, OR, 2.33, 95% confidence interval 1.81-3.00; CHA<sub>2</sub>DS<sub>2</sub>-VASc: OR 3.01, 2.00-4.80), good functional outcomes (CHADS<sub>2</sub>: OR 0.47, 0.39-0.57; CHA<sub>2</sub>DS<sub>2</sub>-VASc: OR 0.55, 0.42-0.71) and SCAEs (CHADS<sub>2</sub>: OR 1.76, 1.28-2.42; CHA<sub>2</sub>DS<sub>2</sub>-VASc: OR 2.69, 1.53-4.73) after adjusting for baseline differences in neurological impairment, tPA use and AF. The pre-stroke CHA<sub>2</sub>DS<sub>2</sub>-VASc score is better than the CHADS<sub>2</sub> 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 CHA<sub>2</sub>DS<sub>2</sub>-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 CHA<sub>2</sub>DS<sub>2</sub>-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. <b><i>Conclusions:</i></b> The pre-stroke CHA<sub>2</sub>DS<sub>2</sub>-VASc 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.
**背景：** CHADS₂评分（CHADS₂）与CHA₂DS₂-VASc评分是经过验证的心房颤动（atrial fibrillation，AF）患者卒中风险评估工具。本研究旨在探究这两种评分是否与3个月卒中预后相关，并评估其在伴或不伴心房颤动的患者中对3个月卒中预后的分层价值。**方法：** 我们分析了来自虚拟国际卒中试验档案（Virtual International Stroke Trials Archive）的6612例急性缺血性卒中患者，这些患者均接受了安慰剂或未合并显著心脏并发症的无效阳性治疗。研究结局指标包括3个月死亡率、定义为改良Rankin量表（modified Rankin Scale）评分≤1的良好功能预后，以及定义为急性冠状动脉综合征、症状性心力衰竭、心搏骤停、致命性心律失常及心源性死亡之一的严重心脏不良事件（serious cardiac adverse events，SCAEs）。采用二元logistic回归分析卒中前CHADS₂评分与CHA₂DS₂-VASc评分和3个月卒中预后的关联；通过受试者工作特征曲线下面积（area under the receiver operator characteristic curves，AUC）评估两种评分对3个月卒中预后的预测效能，并采用χ²检验进行组间比较。**结果：** 本研究队列中，26.5%的患者合并心房颤动，35.3%接受了静脉组织型纤溶酶原激活剂（intravenous tissue plasminogen activator，tPA）治疗，17.7%的患者在3个月时死亡，25.1%达到良好功能预后，9.5%的患者在3个月时发生至少1次SCAEs。在校正神经功能缺损基线差异、tPA使用情况及心房颤动状态后，卒中前高风险（≥2分）的CHADS₂评分与CHA₂DS₂-VASc评分均与3个月死亡率相关（CHADS₂：比值比（odds ratio，OR）=2.33，95%置信区间（confidence interval，CI）1.81~3.00；CHA₂DS₂-VASc：OR=3.01，95%CI 2.00~4.80）、良好功能预后（CHADS₂：OR=0.47，95%CI 0.39~0.57；CHA₂DS₂-VASc：OR=0.55，95%CI 0.42~0.71）及SCAEs（CHADS₂：OR=1.76，95%CI 1.28~2.42；CHA₂DS₂-VASc：OR=2.69，95%CI 1.53~4.73）。在伴或不伴心房颤动的患者中，卒中前CHA₂DS₂-VASc评分对3个月卒中预后的预测效能均优于CHADS₂评分（所有AUC比较P≤0.005）。卒中前高风险CHA₂DS₂-VASc评分在3个月内对死亡率具有较高的敏感性（伴心房颤动：0.96，95%CI 0.94~0.98；不伴心房颤动：0.88，95%CI 0.86~0.91），对SCAEs具有较高的阴性预测值（伴心房颤动：0.93，95%CI 0.87~0.96；不伴心房颤动：0.96，95%CI 0.95~0.97）。卒中前低风险CHA₂DS₂-VASc评分在3个月时对良好功能预后具有较高的特异性（伴心房颤动：0.99，95%CI 0.98~0.994；不伴心房颤动：0.94，95%CI 0.93~0.95）。**结论：** 卒中前CHA₂DS₂-VASc评分似乎是一种简便工具，可用于识别伴或不伴心房颤动的缺血性卒中患者在卒中后3个月内发生不良预后及严重心脏并发症的低风险人群。
