Yonsei Med J.  2022 Apr;63(4):317-324. 10.3349/ymj.2022.63.4.317.

Stroke and Systemic Thromboembolism according to CHA 2 DS 2 -VASc Score in Contemporary Korean Patients with Atrial Fibrillation

  • 1Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
  • 2Department of Cardiology, School of Medicine, Ewha Woman’s University, Seoul, Korea
  • 3Department of Cardiology, School of Medicine, Ewha Woman’s University, Seoul, Korea
  • 4Division of Cardiology, Eulji University Hospital, Daejeon, Korea
  • 5Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • 6Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea
  • 7Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
  • 8Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea
  • 9Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea
  • 10Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea


The incidence of stroke and/or systemic thromboembolism (SSE) has not been properly evaluated in well-anticoagulated atrial fibrillation (AF) patients. This study investigated the incidence of SSE according to CHA2DS2-VASc score in contemporary well-anticoagulated Korean AF patients.
Materials and Methods
From the prospective multicenter COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation (CODE-AF) registry, we identified 9503 patients with non-valvular AF (mean age, 68±8 years; female 35.5%) enrolled between June 2016 and May 2020 with eligible follow-up visits. Stroke incidence in the CODE-AF registry was compared with that in an oral anticoagulant (OAC)-naïve AF cohort from the Korean National Health Insurance database.
The usage rates of OACs and antiplatelet agents were 73.5% (non-vitamin K OACs, 56.4%; warfarin, 17.1%) and 23.8%, respectively. During a mean follow-up period of 26.3±9.6 months, 163 (0.78 per 100 person-years) patients had SSE. The incidence rate (per 100 person-years) of SSE was 0.77 in the total population, 0.26 in low-risk patients [CHA2DS2-VASc score 0 (male) or 1 (female)], and 0.88 in high-risk patients (CHA2DS2-VASc score ≥2). Contemporary AF patients had a stroke rate that was about one-fifth the stroke rate reported in a Korean OAC-naïve AF cohort. In this cohort, most risk factors for CHA2DS2-VASc score showed significant associations with SSE. Female sex was not associated with an increased risk of stroke/SSE in well-anticoagulated AF patients.
Contemporary AF patients have a stroke rate about one-fifth that in OAC-naïve AF patients and exhibit different stroke risk factors.


Atrial fibrillation; stroke; embolism; risk
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