University of Oulu

Tuomas Kiviniemi, Joonas Lehto, Maunu Nissinen, Tuomo Nieminen, Juha Hartikainen, Markus Malmberg, Fredrik Yannopoulos, Jyri Savolainen, Pasi Karjalainen, K.E. Juhani Airaksinen, Stefano Rosato, Fausto Biancari, Performance of CHA2DS2-VASc score for stroke prediction after surgical aortic valve replacement, The Journal of Thoracic and Cardiovascular Surgery, Volume 157, Issue 3, 2019, Pages 896-904, ISSN 0022-5223,

Performance of CHA2DS2-VASc score for stroke prediction after surgical aortic valve replacement

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Author: Kiviniemi, Tuomas1; Lehto, Joonas1; Nissinen, Maunu2;
Organizations: 1Heart Center, Turku University Hospital and University of Turku, Turku, Finland
2Heart Center, Kuopio University Hospital, Kuopio, Finland
3Department of Internal Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
4Department of Internal Medicine, South Karelia Central Hospital, Lappeenranta, Finland
5Department of Surgery, Oulu University Hospital, Oulu, Finland
6Heart Center, Satakunta Central Hospital, Pori, Finland
7Centre for Global Health, Italian Health Institute, Rome, Italy
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.2 MB)
Persistent link:
Language: English
Published: Elsevier, 2019
Publish Date: 2019-10-22


Objective: Stroke is a frequent complication occurring early and late after surgical aortic valve replacement. There is an unmet clinical need for simple tools to assess postoperative stroke risk. We sought to assess the predictive performance of Congestive heart failure; Hypertension; Age ≥75 (doubled); Diabetes mellitus; prior Stroke, transient ischemic attack or thromboembolism (doubled); Vascular disease; Age 65 to 74; Sex category (female) (CHA₂DS₂-VASc) score in patients undergoing surgical aortic valve replacement with a bioprosthesis.

Methods: Seven hundred fourteen patients undergoing isolated surgical aortic valve replacement with a bioprosthesis at 4 university hospitals were included. Data were collected retrospectively from patient records and monitored by an independent party.

Results: Median follow-up time was 4.8 years. Mean CHA₂DS₂-VASc score was 4.1 ± 1.6. Low (scores, 0–1), high (scores, 2–4), and very high (scores, 5–9) CHA₂DS₂-VASc scores were observed in 39 (5.5%), 400 (56.0%), and 262 (38.5%) patients, respectively. Incidences of stroke or transient ischemic attack at 1 year were 2.6%, 4.8%, and 10.7%; at 5 years incidences were 5.2%, 14.0%, and 21.9%; and at 10 years incidence were 5.2%, 20.7%, and 37.9% for patients in low, high, and very high scores, respectively. Incidences of major bleeds at 1 year were 0%, 1.8%, and 2.7%; at 5 years incidences were 0%, 5.4%, and 8.7%; and at 10 years incidences were 0%, 9.0%, and 27.1%, respectively. Competing risk analysis showed that patients with CHA₂DS₂-VASc score of 5 through 9 had a significantly increased risk of stroke or transient ischemic attack (hazard ratio, 4.75; 95% confidence interval, 1.09–20.6; P = .037) irrespective of preoperative or new-onset in-hospital atrial fibrillation compared with low-risk patients.

Conclusions: CHA₂DS₂-VASc is a valuable tool to identify patients with increased risk of stroke and major bleeding, and for whom alternative strategies for prevention of late neurologic complications should be adopted.

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Series: Journal of thoracic and cardiovascular surgery
ISSN: 0022-5223
ISSN-E: 1097-685X
ISSN-L: 0022-5223
Volume: 157
Issue: 3
Pages: 896 - 904
DOI: 10.1016/j.jtcvs.2018.06.096
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Copyright information: © 2018 by The American Association for Thoracic Surgery. This manuscript version is made available under the CC-BY-NC-ND 4.0 license