Lau Kui-Kai, Chan Pak-Hei, Yiu Kai-Hang, Chan Yap-Hang, Liu Shasha, Chan Koon-Ho, Yeung Chun-Yip, Li Sheung-Wai, Tse Hung-Fat, Siu Chung-Wah
The University of Hong Kong.
Cardiol J. 2014;21(5):474-83. doi: 10.5603/CJ.a2014.0034. Epub 2014 May 20.
Patients with myocardial infarction (MI) are at risk of the development of atrial fibrillation (AF) and ischemic stroke. We sought to evaluate the prognostic performance of the CHADS₂ and CHA₂DS₂-VASc scores in predicting new AF and/or ischemic stroke in post-ST segment elevation MI (STEMI) patients. Six hundred and seven consecutive post-STEMI patients with no previously documented AF were studied.
After a follow-up of 63 months (3,184 patient-years), 83 (13.7%) patients developed new AF (2.8% per year). Patients with a high CHADS₂ and/or CHA₂DS₂-VASc score were more likely to develop new AF. The annual incidence of new AF was 1.18%, 2.10%, 4.52%, and 7.03% in patients with CHADS₂ of 0, 1, 2, and ≥ 3; and 0.39%, 1.72%, 1.83%, and 5.83% in patients with a CHA₂DS₂-VASc score of 1, 2, 3 and ≥ 4. The CHA₂DS₂-VASc score (C-statistic = 0.676) was superior to the CHADS₂ (C-statistic = 0.632) for discriminating new AF. Ischemic stroke occurred in 29 patients (0.9% per year), the incidence increasing in line with the CHADS₂ (0.41%, 1.02%, 1.11%, and 1.95% with score of 0, 1, 2, and ≥ 3) and CHA₂DS₂-VASc scores (0.39%, 0.49%, 1.02%, and 1.48% with score of 1, 2, 3 and ≥ 4). The C-statistic of the CHA₂DS₂-VASc score as a predictor of ischemic stroke was 0.601, superior to that of CHADS₂ score (0.573). CHADS₂ and CHA₂DS₂-VASc scores can identify post-STEMI patients at high risk of AF and stroke.
The CHADS₂ and CHA₂DS₂-VASc scores can identify post-STEMI patients at high risk of AF and ischemic stroke. This enables close surveillance and prompt anticoagulation for stroke prevention.
心肌梗死（MI）患者有发生心房颤动（AF）和缺血性卒中的风险。我们旨在评估CHADS₂和CHA₂DS₂-VASc评分在预测ST段抬高型心肌梗死（STEMI）患者新发AF和/或缺血性卒中方面的预后性能。对607例既往无AF记录的连续STEMI患者进行了研究。
经过63个月（3184患者年）的随访，83例（13.7%）患者发生新发AF（每年2.8%）。CHADS₂和/或CHA₂DS₂-VASc评分高的患者更易发生新发AF。CHADS₂评分为0、1、2和≥3的患者新发AF的年发生率分别为1.18%、2.10%、4.52%和7.03%；CHA₂DS₂-VASc评分为1、2、3和≥4的患者分别为0.39%、1.72%、1.83%和5.83%。CHA₂DS₂-VASc评分（C统计量=0.676）在区分新发AF方面优于CHADS₂评分（C统计量=0.632）。29例患者发生缺血性卒中（每年0.9%），其发生率随CHADS₂评分（评分为0、1、2和≥3时分别为0.41%、1.02%、1.11%和1.95%）和CHA₂DS₂-VASc评分（评分为1、2、3和≥4时分别为0.39%、0.49%、1.02%和1.48%）升高而增加。CHA₂DS₂-VASc评分作为缺血性卒中预测指标的C统计量为0.601，优于CHADS₂评分（0.573）。CHADS₂和CHA₂DS₂-VASc评分可识别出有AF和卒中高风险的STEMI患者。
CHADS₂和CHA₂DS₂-VASc评分可识别出有AF和缺血性卒中高风险的STEMI患者。这有助于进行密切监测并及时进行抗凝以预防卒中。
