采用 CHA2DS2-VASc 评分对亚洲“低危”房颤患者进行卒中风险分层细化。
Using the CHA2DS2-VASc score for refining stroke risk stratification in 'low-risk' Asian patients with atrial fibrillation.
机构信息
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.
Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Public Health and School of Medicine, National Yang-Ming University, Taipei, Taiwan.
出版信息
J Am Coll Cardiol. 2014 Oct 21;64(16):1658-65. doi: 10.1016/j.jacc.2014.06.1203.
BACKGROUND
A new scoring system, the anticoagulation and risk factors in atrial fibrillation (ATRIA) score, was proposed for risk stratification in patients with atrial fibrillation (AF). Whether the ATRIA scheme can adequately identify patients who are at low risk of ischemic stroke remains unknown.
OBJECTIVES
The goal of the present study was to compare the performance of ATRIA to that of CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75, diabetes mellitus, prior stroke or transient ischemic attack, vascular disease, age 65 to 74, female) scores for stroke prediction.
METHODS
This study used the National Health Insurance research database in Taiwan. A total of 186,570 AF patients without antithrombotic therapy were selected as the study cohort. The clinical endpoint was the occurrence of ischemic stroke.
RESULTS
During the follow-up of 3.4 ± 3.7 years, 23,723 patients (12.7%) experienced ischemic stroke. The CHA2DS2-VASc score performed better than ATRIA score in predicting ischemic stroke as assessed by c-indexes (0.698 vs. 0.627, respectively; p < 0.0001). The CHA2DS2-VASc score also improved the net reclassification index by 11.7% compared with ATRIA score (p < 0.0001). Among 73,242 patients categorized as low-risk on the basis of an ATRIA score of 0 to 5, the CHA2DS2-VASc scores ranged from 0 to 7, and annual stroke rates ranged from 1.06% to 13.33% at 1-year follow-up and from 1.15% to 8.00% at 15-year follow-up. The c-index of CHA2DS2-VASc score (0.629) was significantly higher than that of the ATRIA score (0.593) in this "low-risk" category (p < 0.0001).
CONCLUSIONS
Patients categorized as low-risk by use of the ATRIA score were not necessarily low-risk, and the annual stroke rates can be as high as 2.95% at 1-year follow-up and 2.84% at 15-year follow-up. In contrast, patients with a CHA2DS2-VASc score of 0 had a truly low risk of ischemic stroke, with an annual stroke rate of approximately 1%.
背景
一种新的评分系统，即抗凝和心房颤动（ATRIA）评分中的危险因素评分，被提出用于心房颤动（AF）患者的风险分层。ATRIA 方案是否能充分识别发生缺血性卒中风险较低的患者仍不清楚。
目的
本研究旨在比较 ATRIA 评分与 CHA2DS2-VASc（充血性心力衰竭、高血压、年龄≥75 岁、糖尿病、既往卒中或短暂性脑缺血发作、血管疾病、年龄 65 岁至 74 岁、女性）评分对卒中预测的性能。
方法
本研究使用了台湾全民健康保险研究数据库。共纳入 186570 例无抗栓治疗的 AF 患者作为研究队列。临床终点为缺血性卒中的发生。
结果
在 3.4±3.7 年的随访中，23723 例（12.7%）患者发生缺血性卒中。CHA2DS2-VASc 评分在预测缺血性卒中方面的表现优于 ATRIA 评分，其 C 指数分别为 0.698 和 0.627（p<0.0001）。与 ATRIA 评分相比，CHA2DS2-VASc 评分还将净重新分类指数提高了 11.7%（p<0.0001）。在根据 ATRIA 评分 0 至 5 分被归类为低危的 73242 例患者中，CHA2DS2-VASc 评分范围为 0 至 7，1 年随访时的年卒中发生率为 1.06%至 13.33%，15 年随访时为 1.15%至 8.00%。在这一“低危”人群中，CHA2DS2-VASc 评分的 C 指数（0.629）明显高于 ATRIA 评分（0.593）（p<0.0001）。
结论
使用 ATRIA 评分归类为低危的患者并不一定是低危患者，1 年随访时的年卒中发生率高达 2.95%，15 年随访时为 2.84%。相比之下，CHA2DS2-VASc 评分为 0 的患者确实具有较低的缺血性卒中风险，年卒中发生率约为 1%。
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