Abstract
Skor CHADS2 dan CHA2DS2-VASc terkait dengan faktor risiko vaskuler seperti hipertensi, DM, riwayat-stroke/TIA, dan usia lanjut. Peningkatan skor ini cenderung meningkatkan atherosklerosis sehingga kemungkinan akan memperburuk keluaran stroke. Penelitian ini bertujuan untuk mengetahui apakah terdapat hubungan skor CHADS2 dan CHA2DS2-VASc dengan keluaran stroke iskemik. Penelitian ini bersifat observasional analitik dengan pendekatan cross sectional. Sampel penelitian adalah penderita stroke iskemik akut yang dirawat di Rumah Sakit Umum dr. Zainoel Abidin Banda Aceh berjumlah 80 orang terdiri atas 38 pria (usia 60.1 + 9.0 tahun) dan 42 wanita (usia 63.0 + 11.2 tahun). Hasil penilaian keluaran fungsional stroke berdasarkan Indeks Barthel (IB) umumnya membaik/menetap yaitu 78 (97.5%) dan memburuk 2(2.5%) dengan skor CHADS2 terbanyak 2(41,3%), 3(23.8%) dan 4(18.8%), skor CHA2DS2-VASc 2(30.0%), 4(22.55%), 3 dan 5 (17.5%). Penilaian keluaran keparahan stroke berdasarkan National Institutes of Health Stroke Scale (NIHSS) umumnya membaik/menetap yaitu 79 (98.8%) dan memburuk 1 (1.2%) dengan skor CHADS2 terbanyak 2 (40,0%), 3(25.0%) dan 4(20.0%), skor CHA2DS2-VASc 2(30.0%), 4(22.55%), 3 dan 5 (17.5%). Penilaian keluaran stroke berdasarkan modified Rankin Scale (mRS) umumnya skor 1(45.8%) dan 4(21.3%). Skor CHADS2 umumnya 2(41.3%), 3(25.0%) dan 4(20.0%). Skor CHA2DS2-VASc 2(30.0%), 4(22.5%), 3(18.8%) dan 5(17.5%). Skor CHADS2 dan CHA2DS2-VASc menunjukkan hubungan yang bermakna dengan keluaran fungsional stroke (IB, IK95%, p=0.047 dan p=0.045), keluaran keparahan stroke (NIHSS; IK95%,p=0.000 dan p=0.000) dan keluaran disabilitas stroke (mRS; IK95%,p=0.000 dan p=0.000). Semakin tinggi Skor CHADS2 dan CHA2DS2-VASc semakin memburuk keluaran stroke karena kecenderungan peningkatan atherosklerosis pada pembuluh darah otak.
References
A. Boehme, C. Esenwa, M.E. (2018) ‘Stroke: Risk factors and prevention’, Journal of the Pakistan Medical Association, 60(3), p. 412. Available at: https://doi.org/10.1161/CIRCRESAHA.116.308398.Stroke.
Banerjee, C. and Chimowitz, M.I. (2017) ‘Stroke Caused by Atherosclerosis of the Major Intracranial Arteries’, Circulation Research, 120(3), pp. 502–513. Available at: https://doi.org/10.1161/CIRCRESAHA.116.308441.
Castilla, E. et al. (2016) ‘Use of the CHADS2 score as a predictor of the risk of mortality in hypertensive patients. The FAPRES study’, Medicina Clínica (English Edition), 146(11), pp. 478–483. Available at: https://doi.org/10.1016/j.medcle.2016.07.002.
Duncan, P.W., Jorgensen, H.S. and Wade, D.T. (2000) ‘Outcome measures in acute stroke trials: A systematic review and some recommendations to improve practice’, Stroke, 31(6), pp. 1429–1438. Available at: https://doi.org/10.1161/01.STR.31.6.1429.
Gimbrone, M.A. and García-Cardeña, G. (2016) ‘Endothelial Cell Dysfunction and the Pathobiology of Atherosclerosis’, Circulation Research, 118(4), pp. 620–636. Available at: https://doi.org/10.1161/CIRCRESAHA.115.306301.
Hao, Q. et al. (2020) ‘A New Transcranial Doppler Scoring System for Evaluating Middle Cerebral Artery Stenosis’, Journal of Neuroimaging, 30(1), pp. 97–103. Available at: https://doi.org/10.1111/jon.12678.
Hoshino, T. et al. (2014) ‘CHADS2, CHA2DS2-VASc, and R2CHADS2 scores are associated with 3-month functional outcome of stroke in patients with prior coronary artery disease’, Circulation Journal, 78(6), pp. 1481–1485. Available at: https://doi.org/10.1253/circj.CJ-14-0038.
Jebari-Benslaiman, S. et al. (2022) ‘Pathophysiology of Atherosclerosis’, International Journal of Molecular Sciences, 23(6), pp. 1–38. Available at: https://doi.org/10.3390/ijms23063346.
Klop, B., Elte, J.W.F. and Cabezas, M.C. (2013) ‘Dyslipidemia in Obesity: Mechanisms and Potential Targets’, Nutrients, 5(4), pp. 1218–1240. Available at: https://doi.org/10.3390/nu5041218.
Klopfenstein, J.D. et al. (2005) ‘Middle cerebral artery stenosis: Endovascular and surgical options’, Skull Base, 15(3), pp. 175–189. Available at: https://doi.org/10.1055/s-2005-871873.
Kuriakose, D. and Xiao, Z. (2020) ‘Pathophysiology and Treatment of Stroke: Present Status and Future Perspectives’, International Journal of Molecular Sciences, 21(20), pp. 1–24.
Leppert, M.H. et al. (2019) ‘Is Prevalence of Atherosclerotic Risk Factors Increasing Among Young Adults? It Depends on How You Ask’, Journal of the American Heart Association, 8(6), pp. 1–10. Available at: https://doi.org/10.1161/JAHA.118.010883.
McGill, J. et al. (2000) ‘Origin of atherosclerosis in childhood and adolescence’, American Journal of Clinical Nutrition, 72(5 SUPPL.). Available at: https://doi.org/10.1093/ajcn/72.5.1307s.
Melgaard, L. et al. (2015) ‘Assessment of the CHA2DS2-VASc score in predicting ischemic stroke, thromboembolism, and death in patients with heart failure with and without atrial fibrillation’, JAMA - Journal of the American Medical Association, 314(10), pp. E1–E9. Available at: https://doi.org/10.1001/jama.2015.10725.
Milutinović, A., Šuput, D. and Zorc-Pleskovič, R. (2020) ‘Pathogenesis of atherosclerosis in the tunica intima, media, and adventitia of coronary arteries: An updated review’, Bosnian Journal of Basic Medical Sciences, 20(1), pp. 21–30. Available at: https://doi.org/10.17305/bjbms.2019.4320.
Morrone, D. et al. (2020) ‘Mortality prediction of the cha2 ds2-vasc score, the has-bled score, and their combination in anticoagulated patients with atrial fibrillation’, Journal of Clinical Medicine, 9(12), pp. 1–17. Available at: https://doi.org/10.3390/jcm9123987.
Rafieian-Kopaei, M. et al. (2014) ‘Atherosclerosis: Process, indicators, risk factors and new hopes’, International Journal of Preventive Medicine, 5(8), pp. 927–946.
Sacco, R.L. et al. (2013) ‘An updated definition of stroke for the 21st century: A statement for healthcare professionals from the American heart association/American stroke association’, Stroke, 44(7), pp. 2064–2089. Available at: https://doi.org/10.1161/STR.0b013e318296aeca.
Saver, J.L. et al. (2021) ‘Standardized Nomenclature for Modified Rankin Scale Global Disability Outcomes: Consensus Recommendations From Stroke Therapy Academic Industry Roundtable XI’, Stroke, 52(9), pp. 3054–3062. Available at: https://doi.org/10.1161/STROKEAHA.121.034480.
Tousoulis, Di. et al. (2016) ‘Inflammatory cytokines in atherosclerosis: Current therapeutic approaches’, European Heart Journal, 37(22), pp. 1723–1735. Available at: https://doi.org/10.1093/eurheartj/ehv759.
Tu, H.T.H. et al. (2013) ‘Pre-Stroke CHADS2 and CHA2DS2-VASc Scores Are Useful in Stratifying Three-Month Outcomes in Patients with and without Atrial Fibrillation collab on behalf of the VISTA collaborators’, Cerebrovascular Diseases, 36(4), pp. 273–280. Available at: https://doi.org/10.1159/000353670.
Tuo, Q. zhang, Zhang, S. ting and Lei, P. (2022) ‘Mechanisms of neuronal cell death in ischemic stroke and their therapeutic implications’, Medicinal Research Reviews, 42(1), pp. 259–305. Available at: https://doi.org/10.1002/med.21817.
Wityk, R.J. et al. (1998) ‘Proximal extracranial vertebral artery disease in the New England Medical Center Posterior Circulation Registry’, Archives of Neurology, 55(4), pp. 470–478. Available at: https://doi.org/10.1001/archneur.55.4.470.
Xing, Y. et al. (2016) ‘CHADS2 score has a better predictive value than CHA2DS2-VASc score in elderly patients with atrial fibrillation’, Clinical Interventions in Aging, 11, pp. 941–946. Available at: https://doi.org/10.2147/CIA.S105360.
Zhou, M. et al. (2021) ‘Stroke outcome assessment: Optimizing cutoff scores for the Longshi Scale, modified Rankin Scale and Barthel Index’, PLoS ONE, 16(5 May), pp. 1–13. Available at: https://doi.org/10.1371/journal.pone.0251103.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2024 Imran, Farida, Syahrul, Desi Ramayana