CHADS2 score in predicting cerebrovascular events - A meta-analysis

Abstract

The CHADS2 score aims to stratify the risk of cardiovascular events and is useful for the optimization of the therapeutic choices in patients with moderate / high risk. This metaanalysis aims to ascertain whether the CHADS2 score is effective in predicting cerebrovascular events in patients with atrial fibrillation (AF). We performed a literature search in PubMed, Embase and Scielo, from March 2011 to April 2012. The studies were selected according to predetermined criteria. Six cohort observational and prospective studies evaluating the predictive ability of CHADS2 score for cerebrovascular events and death were included in the meta-analysis. Defined endpoints (mortality and/or non-fatal stroke) were compared between patients with CHADS2 < 2 and patients with CHADS2 > 2, also considering the presence/absence of AF. With regard to the occurrence of cardiovascular events, for the combined outcome and death/non-fatal stroke individually, there was a greater risk in the group with CHADS2 score > 2, with an OR of 2.92 (CI: 2.08-4.10; p<0.00001), 2.85 (CI: 2.23-3.65; p<0.00001) and 3.23 (CI: 2.11-4.94; p<0.00001), respectively. This study also demonstrated that the risk of cardiovascular events was higher for individuals with CHADS2 > 2, regardless of the presence of AF: OR=2.93 (CI: 2.81-3.06; p<0.00001) in patients with AF; OR=2.94 (CI: 2.87-3.01; p<0.00001) in patients without AF. The results clearly indicate the discriminative capacity of the CHADS2 score for cerebrovascular events, regardless of the presence or absence of AF. Therefore, the CHADS2 score allows the identification of patients at moderate/high risk and the selection of appropriate therapeutic strategies.