Cardiac Surgery Department, General University Hospital of Valencia, Valencia, Spain.
J Thorac Cardiovasc Surg. 2012 Dec;144(6):1428-35. doi: 10.1016/j.jtcvs.2012.07.053. Epub 2012 Aug 24.
Neurologic events after coronary artery bypass grafting are an infrequent but devastating complication. This study analyzed the preoperative predictive abilities of the CHADS(2) and CHA(2)DS(2)VASc stroke scores in patients undergoing isolated coronary artery bypass grafting.
Included in the study were 2910 patients who underwent isolated coronary artery bypass grafting during a 19-year period. CHADS(2) and CHA(2)DS(2)VASc scores were computed for all patients, and outcomes were evaluated in terms of perioperative stroke and compared with 2 specific models for predicting surgical coronary artery bypass grafting stroke (Northern New England Cardiovascular Disease Study Group and Multicenter Study of Perioperative Ischemia Research Group). Perioperative stroke discrimination was quantified by computing the area under the receiver operating characteristic curve.
Overall, 62 (2.1%) had perioperative strokes. Areas under the curve were 0.71 (95% confidence interval, 0.64-0.78) for CHADS(2), 0.72 (95% confidence interval, 0.65-0.79) for CHA(2)DS(2)VASc, 0.69 (95% confidence interval, 0.61-0.76) for Northern New England Cardiovascular Disease Study Group, and 0.73 (95% confidence interval, 0.67-0.80) for Multicenter Study of Perioperative Ischemia Research Group scores. Northern New England Cardiovascular Disease Study Group and CHA(2)DS(2)VASc scores were better at discriminating patients with particularly low or high risk of stroke.
CHADS(2) and CHA(2)DS(2)VASc scores predicted perioperative coronary artery bypass grafting strokes with discriminatory abilities similar to those of specific predictive surgical coronary artery bypass grafting stroke models. All schemes tested showed similar limitations in discriminating patients with high postoperative stroke risk, with a high proportion being classified as having intermediate stroke risk.
冠状动脉旁路移植术后的神经系统事件是一种罕见但具有破坏性的并发症。本研究分析了 CHADS₂ 和 CHA₂DS₂-VASc 卒中评分在接受单纯冠状动脉旁路移植术患者中的术前预测能力。
本研究纳入了 2910 例在 19 年内接受单纯冠状动脉旁路移植术的患者。为所有患者计算 CHADS₂ 和 CHA₂DS₂-VASc 评分，并根据围术期卒中评估结果进行比较，并与 2 种特定的预测外科冠状动脉旁路移植术卒中模型（新英格兰北部心血管疾病研究组和多中心围手术期缺血研究组）进行比较。通过计算受试者工作特征曲线下面积来量化围术期卒中的判别能力。
共有 62 例（2.1%）发生围术期卒中。CHADS₂ 的曲线下面积为 0.71（95%置信区间，0.64-0.78），CHA₂DS₂-VASc 的曲线下面积为 0.72（95%置信区间，0.65-0.79），新英格兰北部心血管疾病研究组的曲线下面积为 0.69（95%置信区间，0.61-0.76），多中心围手术期缺血研究组的曲线下面积为 0.73（95%置信区间，0.67-0.80）。新英格兰北部心血管疾病研究组和 CHA₂DS₂-VASc 评分在区分低危和高危卒中患者方面更具优势。
CHADS₂ 和 CHA₂DS₂-VASc 评分预测冠状动脉旁路移植术后卒中的能力与特定的预测外科冠状动脉旁路移植术卒中模型相似。所有测试的方案在区分高术后卒中风险的患者方面都存在类似的局限性，其中很大一部分被归类为具有中等卒中风险。
