Cardiology Department, Coimbra's Hospital and University Centre, Coimbra, Portugal.
Thromb Res. 2013 Aug;132(2):293-9. doi: 10.1016/j.thromres.2013.06.025. Epub 2013 Aug 5.
A new risk stratification scheme incorporating the original CHADS2 score and renal function, entitled R(2)CHADS(2), was validated in the ROCKET-AF and ATRIA study cohorts.
Adjusting and validating a modified R-CHA2DS2VASc score as a predictor of ischaemic stroke and all-cause mortality in patients discharged following admission for a Myocardial Infarction (MI).
Observational retrospective single-centre cohort study including 1711 patients admitted with MI and discharged alive. We tested the prognostic performance of R-CHA2DS2VASc, based on the original CHA2DS2VASc score with few modifications (addition of renal function parameters [glomerular filtration rate and urea], performance of a revascularization procedure and history of atrial fibrillation). R-CHA2DS2VASc was evaluated for its discriminative performance and calibration in the prediction of ischaemic stroke (primary endpoint), all-cause mortality and a composite endpoint of ischemic stroke plus all-cause mortality (secondary outcomes) during follow-up.
R-CHA2DS2VASc score's areas under the curve (AUC) for the occurrence of primary and secondary outcomes were: Ischaemic stroke: AUC 0.717 ± 0.031, p<0.001 (vs. 0.681 ± 0.043 for CHA2DS2VASc, p=0.290); all-cause mortality during follow-up: AUC 0.811 ± 0.014, p<0.001 (vs. 0.782 ± 0.019 for GRACE, p=0.245); composite endpoint: AUC 0.803 ± 0.014, p<0.001. The integrated discrimination improvement index (IDI) and relative IDI for the primary endpoint were 0.015 and 28.2%, respectively, while the IDI and relative IDI for all-cause mortality were 0.13 and 72.1%, suggesting a large improvement in risk stratification. An R-CHA2DS2VASc score below 3 had a negative predictive value of 98.6% for the occurrence of ischaemic stroke.
The modified R-CHA2DS2VASc score has shown good calibration and high discriminative performance in the prediction of post-discharge ischaemic stroke and all-cause mortality. The inclusion of renal function in thromboembolic risk predicting schemes seems warranted.
一种新的风险分层方案，纳入了原始 CHADS2 评分和肾功能，命名为 R(2)CHADS(2)，在 ROCKET-AF 和 ATRIA 研究队列中得到了验证。
调整和验证改良后的 R-CHA2DS2VASc 评分，作为预测心肌梗死后出院患者发生缺血性卒中和全因死亡率的指标。
这是一项观察性回顾性单中心队列研究，纳入了 1711 例因心肌梗死住院并存活出院的患者。我们测试了基于原始 CHA2DS2VASc 评分的 R-CHA2DS2VASc 预测缺血性卒中和全因死亡率的预后性能（评分中添加了肾功能参数[肾小球滤过率和尿素]、血运重建术和心房颤动史）。在随访期间，评估 R-CHA2DS2VASc 预测缺血性卒中等主要终点和全因死亡率以及缺血性卒中和全因死亡率复合终点（次要结局）的判别性能和校准性能。
R-CHA2DS2VASc 评分对主要和次要结局的曲线下面积（AUC）分别为：缺血性卒中等主要终点 AUC 0.717 ± 0.031，p<0.001（与 CHA2DS2VASc 的 0.681 ± 0.043 相比，p=0.290）；全因死亡率 AUC 0.811 ± 0.014，p<0.001（与 GRACE 的 0.782 ± 0.019 相比，p=0.245）；复合终点 AUC 0.803 ± 0.014，p<0.001。对于主要终点，综合判别改善指数（IDI）和相对 IDI 分别为 0.015 和 28.2%，而全因死亡率的 IDI 和相对 IDI 分别为 0.13 和 72.1%，表明风险分层有较大改善。R-CHA2DS2VASc 评分<3 时，对缺血性卒中等的发生具有 98.6%的阴性预测值。
改良后的 R-CHA2DS2VASc 评分在预测出院后缺血性卒中和全因死亡率方面具有良好的校准度和较高的判别性能。在血栓栓塞风险预测方案中纳入肾功能似乎是合理的。
