Department of Internal Medicine, School of Medicine, Iwate Medical University, Japan.
J Cardiol. 2012 May;59(3):321-8. doi: 10.1016/j.jjcc.2012.01.003. Epub 2012 Mar 2.
The CHA(2)DS(2)-VASc score has been newly proposed for stratifying patients with nonvalvular atrial fibrillation (AF) according to the risk of ischemic stroke in the 2010 European Society of Cardiology guideline. However, there is little information about its usefulness for predicting long-term prognosis of cardiovascular events in Japanese patients with paroxysmal AF. This study retrospectively included 332 paroxysmal AF patients (224 men, mean age 65±13 years, mean follow-up period 53±35 months) without receiving anticoagulant therapy between June 1995 and August 2008 who were categorized into risk stratification on the basis of CHA(2)DS(2)-VASc score.
The distribution of CHA(2)DS(2)-VASc scores was 0, 1, 2, 3, 4, 5, 6, and 7 points in 76 (23%), 60 (18%), 69 (21%), 69 (21%), 28 (8%), 23 (7%), 6 (2%), and 1 (0.3%) patients, respectively. The annual rates of symptomatic ischemic stroke were 0%, 0.60%, 0.95%, 1.96%, 5.45%, 9.06%, and 13.7% when the CHA(2)DS(2)-VASc score was 0, 1, 2, 3, 4, 5, and ≥6 points, respectively (p<0.001) and those of cardiovascular events including hospitalization for thromboembolism, heart failure and cardiovascular death were 0%, 1.43%, 1.50%, 2.52%, 10.14%, 12.85%, and 17.13% when the CHA(2)DS(2)-VASc score was 0, 1, 2, 3, 4, 5 and ≥6 points, respectively (p<0.001). Higher CHA(2)DS(2)-VASc scores were associated with greater annual rates of ischemic stroke and cardiovascular events. In a multivariate logistic regression analysis adjusted for the potentially confounding variables, the CHA(2)DS(2)-VASc score was associated with symptomatic ischemic stroke (odds ratio 7.051, 95% confidence interval 3.76-13.22, p<0.001) and cardiovascular events (odds ratio 3.448, 95% confidence interval 2.33-5.11, p<0.001).
In Japanese patients with paroxysmal AF, the CHA(2)DS(2)-VASc score is a useful scheme for risk stratification of ischemic stroke and cardiovascular events.
2010 年欧洲心脏病学会指南提出 CHA(2)DS(2)-VASc 评分，用于对非瓣膜性心房颤动（房颤）患者发生缺血性卒中的风险进行分层。然而，关于该评分在预测日本阵发性房颤患者的心血管事件长期预后方面的作用，相关信息较少。本研究回顾性纳入了 1995 年 6 月至 2008 年 8 月期间未接受抗凝治疗的 332 例阵发性房颤患者（224 例男性，平均年龄 65±13 岁，平均随访时间 53±35 个月），并根据 CHA(2)DS(2)-VASc 评分进行风险分层。
CHA(2)DS(2)-VASc 评分分别为 0、1、2、3、4、5、6 和 7 分的患者分别有 76 例（23%）、60 例（18%）、69 例（21%）、69 例（21%）、28 例（8%）、23 例（7%）、6 例（2%）和 1 例（0.3%）。当 CHA(2)DS(2)-VASc 评分为 0、1、2、3、4、5 和≥6 分时，症状性缺血性卒中年发生率分别为 0%、0.60%、0.95%、1.96%、5.45%、9.06%和 13.7%（p<0.001）；当 CHA(2)DS(2)-VASc 评分为 0、1、2、3、4、5 和≥6 分时，包括血栓栓塞、心力衰竭和心血管死亡在内的心血管事件的年发生率分别为 0%、1.43%、1.50%、2.52%、10.14%、12.85%和 17.13%（p<0.001）。多变量 logistic 回归分析调整了潜在混杂因素后，CHA(2)DS(2)-VASc 评分与症状性缺血性卒中和心血管事件相关（比值比分别为 7.051，95%置信区间为 3.76-13.22，p<0.001）。
在日本阵发性房颤患者中，CHA(2)DS(2)-VASc 评分是一种评估缺血性卒中和心血管事件风险的有用方案。
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