Department of Community Medicine and Epidemiology, Carmel Medical Center, Clalit Health Services, and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Internal Medicine C, Ha'emek Medical Center, Afula, Israel.
Department of Community Medicine and Epidemiology, Carmel Medical Center, Clalit Health Services, and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Department of Epidemiology and Disease Prevention, Office of the Chief Physician, Clalit Health Services Headquarters, Tel Aviv, Israel.
Am J Med. 2014 Jan;127(1):45-52. doi: 10.1016/j.amjmed.2013.10.004. Epub 2013 Oct 15.
The risk stratification score, which includes Congestive heart failure, Hypertension, Age ≥ 75 [doubled], Diabetes, Stroke [doubled]- Vascular disease, Age 65-74, and Sex category [female] (CHA2DS2-VASc), is used to predict stroke in atrial fibrillation. However, whether high CHA2DS2-VASc score carries a higher risk of pulmonary embolism remains unknown. We aimed to investigate the association between the severity of CHA2DS2-VASc score and the incidence of pulmonary embolism.
A total of 73,541 adults with atrial fibrillation diagnosed before January 1, 2012, and no history of pulmonary embolism, were retrospectively identified from the computerized database of the Clalit Health Services, which is the largest not-for-profit health maintenance organization in Israel. The CHA2DS2-VASc score was calculated for each subject at study entry. The cohort was followed for the first occurrence of pulmonary embolism until December 31, 2012 (70,210 person-years).
Pulmonary embolism developed in 158 subjects, representing an incidence of 225.0 per 100,000 person-years. The incidence of pulmonary embolism increased with increasing CHA2DS2-VASc score (P < .001). On Cox proportional analysis, CHA2DS2-VASc score was significantly associated with pulmonary embolism (hazard ratio, 1.22; 95% confidence interval [CI], 1.13-1.32) for a 1-point increase in CHA2DS2-VASc score. The results were similar after adjusting for anticoagulants and antiplatelet use (hazard ratio, 1.24; 95% CI, 1.14-1.34), and remained unchanged after further adjustment for active malignancy. The predictive values for pulmonary embolism were similar for CHA2DS2-VASc score and the classic risk stratification score which includes Congestive heart failure, Hypertension, Age >75 years, Diabetes, and Stroke [doubled] (CHADS2); the areas under the receiver operating characteristic curves were 0.619 (95% CI, 0.579-0.660) and 0.616 (95% CI, 0.575-0.656), respectively.
CHA2DS2-VASc score is directly associated with the incidence of pulmonary embolism in atrial fibrillation.
CHA2DS2-VASc 评分包括充血性心力衰竭、高血压、年龄≥75 岁（加倍）、糖尿病、卒中[加倍]-血管疾病、65-74 岁和性别类别[女性]（CHA2DS2-VASc），用于预测心房颤动中的卒中。然而，高 CHA2DS2-VASc 评分是否与肺栓塞风险增加有关尚不清楚。我们旨在研究 CHA2DS2-VASc 评分严重程度与肺栓塞发生率之间的关系。
从以色列最大的非营利性健康维护组织克拉利特健康服务的计算机数据库中回顾性确定了 73541 名于 2012 年 1 月 1 日前诊断为心房颤动且无肺栓塞史的成年人。在研究入组时为每位受试者计算 CHA2DS2-VASc 评分。该队列随访至 2012 年 12 月 31 日（70210 人年）首次发生肺栓塞。
158 例发生肺栓塞，发生率为 225.0/100000 人年。随着 CHA2DS2-VASc 评分的增加，肺栓塞的发生率也增加（P<.001）。在 Cox 比例风险分析中，CHA2DS2-VASc 评分与肺栓塞显著相关（风险比，1.22；95%置信区间[CI]，1.13-1.32），每增加 1 分 CHA2DS2-VASc 评分。调整抗凝和抗血小板使用后结果相似（风险比，1.24；95%CI，1.14-1.34），进一步调整活动性恶性肿瘤后结果保持不变。CHA2DS2-VASc 评分和包括充血性心力衰竭、高血压、年龄>75 岁、糖尿病和卒中[加倍]（CHADS2）的经典风险分层评分对肺栓塞的预测值相似；受试者工作特征曲线下面积分别为 0.619（95%CI，0.579-0.660）和 0.616（95%CI，0.575-0.656）。
CHA2DS2-VASc 评分与心房颤动中肺栓塞的发生率直接相关。
