Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan.
Stroke. 2012 Oct;43(10):2551-5. doi: 10.1161/STROKEAHA.112.667865. Epub 2012 Aug 7.
Atrial fibrillation (AF) is an independent risk factor for stroke. Recent studies have demonstrated that the CHA(2)DS(2)-VASc scheme is useful for selecting patients who are truly at low risk. The goal of the present study was to compare the risk of ischemic stroke among AF patients with a CHA(2)DS(2)-VASc score of 0 (male) or 1 (female) with those without AF.
The study enrolled 509 males (CHA(2)DS(2)-VASc score=0) and 320 females (CHA(2)DS(2)-VASc score=1) with AF who did not receive any antithrombotic therapy. Patients were selected from the National Health Insurance Research Database in Taiwan. For each study patient, 10 age-matched and sex-matched subjects without AF and without any comorbidity from the CHA(2)DS(2)-VASc scheme were selected as controls. The clinical end point was the occurrence of ischemic stroke.
During a follow-up of 57.4 ± 35.7 months, 128 patients (1.4%) experienced ischemic stroke. The event rate did not differ between groups with and without AF for male patients (1.6% vs 1.6%; P=0.920). In contrast, AF was a significant risk factor for ischemic stroke among females (hazard ratio, 7.77), with event rates of 4.4% and 0.7% for female patients with and without AF (P<0.001).
AF males with a CHA(2)DS(2)-VASc score of 0 were at true low risk for stroke, which was similar to that of non-AF patients. However, AF females with a score of 1 were still at higher risk for ischemic events than non-AF patients.
心房颤动（AF）是中风的独立危险因素。最近的研究表明，CHA （2 ） DS （2 ） -VASc 方案可用于选择真正低危患者。本研究的目的是比较 CHA （2 ） DS （2 ） -VASc 评分为 0 （男性）或 1 （女性）的 AF 患者与无 AF 患者发生缺血性中风的风险。
本研究纳入了 509 名男性（CHA （2 ） DS （2 ） -VASc 评分= 0 ）和 320 名女性（CHA （2 ） DS （2 ） -VASc 评分= 1 ），这些患者患有 AF 但未接受任何抗血栓治疗。患者选自台湾全民健康保险研究数据库。每位研究患者均选择了 10 名年龄和性别匹配且无 AF 且无 CHA （2 ） DS （2 ） -VASc 方案中任何合并症的患者作为对照。临床终点为缺血性中风的发生。
在 57.4 ± 35.7 个月的随访期间，128 名患者（1.4 ％）发生缺血性中风。对于男性患者，有无 AF 组之间的事件发生率无差异（1.6 ％与 1.6 ％； P=0.920 ）。相比之下，AF 是女性发生缺血性中风的重要危险因素（风险比，7.77 ），有 AF 和无 AF 的女性患者的事件发生率分别为 4.4 ％和 0.7 ％（ P<0.001 ）。
CHA （2 ） DS （2 ） -VASc 评分 0 的 AF 男性患者发生中风的风险确实较低，与非 AF 患者相似。但是，评分 1 的 AF 女性患者发生缺血性事件的风险仍高于非 AF 患者。
