Predictive role of CHADS2 and CHA2DS2-VASc scores on stroke and thromboembolism in patients without atrial fibrillation: a meta-analysis.

Objective: CHA(2)DS(2)-VASc is the extension of the CHADS(2) score developed by Birmingham 2009. This risk stratification schema is often used in clinical setting when considering additional risk factors for developing stroke in AF patients. However, its role in the non-AF population is unknown. This study was designed to evaluate the accuracy of the CHADS(2) and the CHA(2)DS(2)-VASc scoring systems. Methods: Studies designed for CHADS(2) and CHA(2)DS(2)-VASc score in stratifying the risks for stroke development in non-AF patients were included. Results: Among the 114 studies identified, six trials were chosen finally and included for meta-analysis. The pooled diagnostic odds ratio (DOR) for CHADS(2) and CHA(2)DS(2)-VASc was 2.86 (95% CI =1.83-4.28) and 2.80 (95% CI =1.83-4.28), respectively. CHA(2)DS(2)-VASc score was of better sensitivity than CHADS(2) score (0.920 vs. 0.768). However, both scores were showed to have inherent heterogeneity and poor specificity. Conclusions: Though having good diagnostic accuracy, the clinical application of the CHADS(2) and CHA(2)DS(2)-VASc scores in predicting risk of stroke development in non-AF patients still needs further validation.