CHADS2 评分与阵发性心房颤动患者抗心律失常药物治疗效果的关系。
Relationship between CHADS2 score and efficacy of antiarrhythmic drug therapy in patients with paroxysmal atrial fibrillation.
机构信息
Division of Cardio-angiology, Nephrology and Endocrinology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan.
出版信息
Circ J. 2013;77(3):639-45. doi: 10.1253/circj.cj-12-0854. Epub 2012 Dec 5.
BACKGROUND
The Cardiac failure, Hypertension, Age, Diabetes, Stroke [Doubled] (CHADS(2)) score is a useful scheme for risk stratification of thromboembolism patients, but there is little information about its usefulness for the evaluation of antiarrhythmic drug (AAD) therapy.
METHODS AND RESULTS
This study included 459 paroxysmal atrial fibrillation (AF) patients (309 men, mean age 66 ± 12 years, mean follow-up 50 ± 35 months) and prophylactic efficacy was analyzed on the basis of CHADS(2) score. (1) Survival rates free from AF recurrence at 1, 6, 12 and 24 months were, respectively, 89%, 74%, 63% and 47% in score-0 group (n=152); 92%, 68%, 59% and 48% in score-1 group (n=158); 86%, 64%, 56% and 46% in score-2 group (n=84); 81%, 65%, 51% and 35% in score-3 group (n=43); and 68%, 50%, 36% and 18% in ≥ score-4 group (n=22) (P<0.05; score-0, score-1 or score-2 vs. ≥ score-4 group). (2) Survival rates free from progression to chronic AF at 12, 36, 60 and 90 months were, respectively, 95%, 93%, 91% and 89% in score-0 group; 97%, 91%, 89% and 88% in score-1 group; 96%, 93%, 88% and 83% in score-2 group; 91%, 74%, 67% and 60% in score-3 group; and 91%, 82%, 68% and 55% in ≥ score-4 group (P<0.01; score-0, score-1 or score-2 vs. ≥ score-4 group). (3) In multivariate logistic regression analysis adjusted for potentially confounding variables, CHADS(2) score was associated with AF recurrence (odds ratio [OR] 1.45, 95% confidence interval [CI] 1.16-1.81, P<0.001), and progression to chronic AF during AAD therapy (OR 1.64, 95% CI 1.04-2.69, P<0.001).
CONCLUSIONS
When using a rhythm control strategy, the CHADS(2) score is a useful scheme for predicting the outcome of AAD treatment of patients with paroxysmal AF.
背景
充血性心力衰竭、高血压、年龄、糖尿病、中风[加倍]（CHADS(2)）评分是血栓栓塞患者风险分层的有用方案，但关于其在评估抗心律失常药物（AAD）治疗中的有用性的信息很少。
方法和结果
本研究纳入了 459 例阵发性心房颤动（AF）患者（309 例男性，平均年龄 66±12 岁，平均随访 50±35 个月），并根据 CHADS(2)评分分析了预防疗效。（1）在 1、6、12 和 24 个月时，无 AF 复发的生存率分别为评分 0 组（n=152）99%、74%、63%和 47%；评分 1 组（n=158）92%、68%、59%和 48%；评分 2 组（n=84）86%、64%、56%和 46%；评分 3 组（n=43）81%、65%、51%和 35%；评分≥4 组（n=22）68%、50%、36%和 18%（P<0.05；评分 0、1 或 2 与≥4 组比较）。（2）在 12、36、60 和 90 个月时，无进展为慢性 AF 的生存率分别为评分 0 组 95%、93%、91%和 89%；评分 1 组 97%、91%、89%和 88%；评分 2 组 96%、93%、88%和 83%；评分 3 组 91%、74%、67%和 60%；评分≥4 组 91%、82%、68%和 55%（P<0.01；评分 0、1 或 2 与≥4 组比较）。（3）在调整了潜在混杂因素的多变量逻辑回归分析中，CHADS(2)评分与 AF 复发（比值比[OR]1.45，95%置信区间[CI]1.16-1.81，P<0.001）和 AAD 治疗期间进展为慢性 AF（OR 1.64，95%CI 1.04-2.69，P<0.001）相关。
结论
当使用节律控制策略时，CHADS(2)评分是预测阵发性 AF 患者 AAD 治疗结果的有用方案。
Zotero 插件