Department of Neurology and Cerebrovascular Medicine, Saitama International Medical Center, Saitama Medical University, Saitama, Japan.
J Stroke Cerebrovasc Dis. 2013 Aug;22(6):846-50. doi: 10.1016/j.jstrokecerebrovasdis.2012.06.006. Epub 2012 Jul 20.
This study investigated the relationship between CHADS2 scores and the rate of antithrombotic drug use and clinical outcomes in patients with an initial cardioembolic stroke who had nonvalvular atrial fibrillation (NVAF).
In 234 patients (135 men and 99 women; mean age [± SD] 76 ± 11 years) with initial cardiogenic cerebral embolism with NVAF who were admitted to our hospital between April 2007 and March 2011, the CHADS2 score, use of warfarin, and clinical outcomes were retrospectively investigated.
CHADS2 scores were as follows: 0 points, n = 21 (9%); 1 point, n = 72 (31%); 2 points, n = 92 (39%); 3 points, n = 47 (20%); and 4 points, n = 2 (1%). The overall warfarin use rate was low (14.1%; n = 33), and it was significantly (P = .023) lower for paroxysmal atrial fibrillation (8%) than for chronic atrial fibrillation (18.5%). The clinical outcomes evaluated by the modified Rankin Scale (mRS) score after 3 months were: CHADS2 score 0 points, mRS 0 to 2 (81%) and 3 to 6 (19%); 1 point, mRS 0 to 2 (46%) and 3 to 6 (54%); 2 points, mRS 0 to 2 (46%) and 3 to 6 (54%); and ≥ 3 points, mRS 0 to 2 (29%) and 3 to 6 (71%). The clinical outcome worsened as the CHADS2 score increased (P = .002). Logistic regression analysis revealed that being ≥ 75 years of age and having a high National Institutes of Health Stroke Scale (NIHSS) score on admission were related to a poor outcome (P < .001).
The overall warfarin use rate was low in initial cardioembolic stroke patients with NVAF. Clinical outcomes deteriorated with increases in the CHADS2 score, age ≥ 75 years, and NIHSS score on admission were related to a poor clinical outcome.
本研究旨在探讨 CHADS2 评分与非瓣膜性心房颤动（NVAF）患者首发心源性脑栓塞后抗栓药物使用和临床结局之间的关系。
对 2007 年 4 月至 2011 年 3 月期间我院收治的 234 例首发心源性脑栓塞合并 NVAF 的患者（男性 135 例，女性 99 例；平均年龄 [± 标准差] 76±11 岁）进行回顾性研究，分析 CHADS2 评分、华法林使用情况及临床结局。
CHADS2 评分：0 分 21 例（9%）；1 分 72 例（31%）；2 分 92 例（39%）；3 分 47 例（20%）；4 分 2 例（1%）。整体华法林使用率较低（14.1%；n=33），阵发性房颤（8%）显著低于慢性房颤（18.5%）（P=0.023）。3 个月时改良 Rankin 量表（mRS）评分评估的临床结局为：CHADS2 评分 0 分，mRS 0-2 分（81%）和 3-6 分（19%）；1 分，mRS 0-2 分（46%）和 3-6 分（54%）；2 分，mRS 0-2 分（46%）和 3-6 分（54%）；≥3 分，mRS 0-2 分（29%）和 3-6 分（71%）。随着 CHADS2 评分的增加，临床结局恶化（P=0.002）。Logistic 回归分析显示，年龄≥75 岁和入院时 NIHSS 评分较高与不良结局相关（P<0.001）。
NVAF 患者首发心源性脑栓塞后华法林整体使用率较低。随着 CHADS2 评分的增加、年龄≥75 岁和入院时 NIHSS 评分的升高，临床结局恶化，与不良临床结局相关。
