Predictive Value of R2CHA2DS2-VA Score for 90-Day Functional Outcomes After Endovascular Thrombectomy in Acute Ischemic Stroke

TL;DR

This study shows that the R2CHA2DS2-VA score is a strong predictor of 90-day recovery outcomes in stroke patients who received endovascular treatment.

Contribution

The study demonstrates that R2CHA2DS2-VA outperforms other scores in predicting functional outcomes after stroke treatment.

Findings

R2CHA2DS2-VA had the highest AUC value (p = 0.0443) for predicting outcomes.

Higher R2CHA2DS2-VA scores were significantly linked to worse outcomes (OR = 1.637).

Longer onset-to-recanalization time and hyperlipidemia were also associated with poor prognosis.

Abstract

Background and Objectives: Endovascular treatment (EVT) has been shown to enhance long-term recovery and lower mortality rates in patients with intracranial large vessel occlusion-associated acute ischemic strokes (AISs).We aimed to evaluate the predictive value of the pre-stroke CHA2DS2-VA, R2CHA2DS2-VA, CHA2DS2-VASc, and R2CHA2DS2-VASc scores in determining 90-day functional outcomes based on the modified Rankin Scale (mRS). Methods: In a single center between 2018 and 2023, 665 AIS patients who underwent EVT and achieved successful reperfusion were screened retrospectively. After inclusion and exclusion criteria, 583 patients were included. Based on 90-day mRS scores, patients were classified into two groups: good (mRS ≤ 2, n = 257) and poor functional outcomes (mRS 3–6, n = 326). The pre-stroke scores were calculated. Results: When ROC curve analysis was performed, R2CHA2DS2-VA demonstrated the highest AUC value (p = 0.0443) among these scores. The optimal cutoff score was determined to be 4, yielding a sensitivity of 75.77% and specificity of 93.39%. In multivariable analysis, a higher R2CHA2DS2-VA score was significantly associated with worse outcomes (OR = 1.637, 95%, CI: 2.436–5.510, p < 0.001). A longer onset-to-recanalization time (OR = 1.009, 95%, CI: 1.005–1.014, p < 0.001) and presence of hyperlipidemia (OR = 2.960, 95%, CI: 1.254–6.988, p = 0.01) were correlated with poor prognosis. Higher baseline NIHSS scores were associated with unfavorable outcomes (OR = 1.201, 95%, CI: 1.014–1.422, p = 0.034), and this association remained significant for NIHSS scores measured 24 h post-EVT (OR = 1.467, 95%, CI: 1.230–1.748, p < 0.001). Conclusions: The R2CHA2DS2-VA score demonstrates superior predictive ability for 90-day functional outcomes in AIS patients treated with EVT, surpassing CHA2DS2-VASc and similar scoring systems.

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