Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Japan.
J Neurol Sci. 2011 Jul 15;306(1-2):49-53. doi: 10.1016/j.jns.2011.03.046. Epub 2011 Apr 14.
The aim of this study was to examine whether CHADS(2) score is associated with clinical outcomes following recombinant tissue type plasminogen activator (rt-PA) therapy in stroke patients with atrial fibrillation (AF).
We studied 218 consecutive stroke patients with AF [126 men, mean age 74.2 (SD 9.6) years] who received intravenous rt-PA therapy. CHADS(2) score was calculated as follows: 2 points for prior ischemic stroke and 1 point for each of the following: age≥75 years, hypertension, diabetes, and congestive heart failure.
Congestive heart failure was documented in 23 patients, hypertension in 138, age≥75 years in 116, diabetes in 35, and prior stroke in 35. The distribution of each CHADS(2) score was: score of 0, 16.1% of patients; 1, 30.3%; 2, 29.4%; and 3 to 5, 24.3%. The median initial NIHSS score for each CHADS(2) category was 12 (IQR 8-17), 16 (10-20), 14.5 (10-20.75), and 16 (11-21), respectively (p=0.168). Symptomatic ICH within the initial 36 h was found in 2.9%, 4.6%, 6.3%, and 0% of patients with each CHADS(2) category, respectively. Cardiovascular events within 3 months occurred in 0%, 0%, 7.8% and 5.7%, respectively. Percentage of patients with chronic independence at 3 months corresponding to modified Rankin Scale≤2 was 57.1%, 45.5%, 31.3%, and 28.3%, respectively. Adjusted CHADS(2) score was inversely associated with chronic independence (OR 0.72, 95% CI 0.55-0.93).
Lower CHADS(2) score was associated with chronic independence at 3 months after intravenous rt-PA therapy in stroke patients with AF.
本研究旨在探讨 CHADS(2)评分与接受重组组织型纤溶酶原激活剂（rt-PA）治疗的伴有心房颤动（AF）的脑卒中患者的临床结局是否相关。
我们研究了 218 例连续的伴有 AF 的脑卒中患者[126 例男性，平均年龄 74.2（9.6）岁]，他们接受了静脉 rt-PA 治疗。CHADS(2)评分如下计算：先前的缺血性脑卒中记 2 分，以下情况各记 1 分：年龄≥75 岁、高血压、糖尿病和充血性心力衰竭。
23 例患者有充血性心力衰竭，138 例患者有高血压，116 例患者年龄≥75 岁，35 例患者有糖尿病，35 例患者有先前的脑卒中。每个 CHADS(2)评分的分布为：0 分，16.1%的患者；1 分，30.3%；2 分，29.4%；3 至 5 分，24.3%。每个 CHADS(2)类别中初始 NIHSS 评分的中位数分别为 12（IQR 8-17）、16（10-20）、14.5（10-20.75）和 16（11-21）（p=0.168）。在最初的 36 小时内，分别有 2.9%、4.6%、6.3%和 0%的患者出现症状性 ICH。3 个月内发生心血管事件的患者分别为 0%、0%、7.8%和 5.7%。3 个月时对应改良 Rankin 量表≤2 的慢性独立性患者百分比分别为 57.1%、45.5%、31.3%和 28.3%。校正后的 CHADS(2)评分与慢性独立性呈负相关（OR 0.72，95%CI 0.55-0.93）。
较低的 CHADS(2)评分与伴有 AF 的脑卒中患者静脉 rt-PA 治疗后 3 个月的慢性独立性相关。
