Podolecki Tomasz, Lenarczyk Radosław, Kowalczyk Jacek, Swierad Marcin, Swiatkowski Andrzej, Jedrzejczyk Ewa, Chodor Piotr, Zielinska Teresa, Kalarus Zbigniew
Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Medical University, Silesian Center of Heart Diseases, Zabrze, Poland.
J Cardiovasc Med (Hagerstown). 2015 Jul;16(7):497-502. doi: 10.2459/JCM.0000000000000241.
The CHA2DS2-VASc score is widely used to stratify the risk of stroke in patients with nonvalvular atrial fibrillation. The aim of the study was to assess whether the CHA2DS2-VASc score might be useful to identify patients at a high risk of ischemic stroke and death among individuals after acute myocardial infarction and with no history of atrial fibrillation.
We analysed consecutive patients with acute myocardial infarction admitted to our centre between 2003 and 2008. On the basis of the CHA2DS2-VASc score, four groups were distinguished: low-risk (1 point), intermediate-risk (2-3 points), high-risk (4-5 points) and very high-risk (>5 points). Data on long-term follow-up were screened to identify patients who experienced stroke or died during remote observation.
Out of 2980 registry participants, 333 were excluded because of atrial fibrillation and/or ongoing therapy with oral anticoagulants. Finally, 2647 individuals were included into the analysis. An ischemic stroke occurred in 71 (2.68%) patients, whereas 439 (16.58%) died during a median follow-up of 41.5 months. The risk of stroke and death increased four-fold in the high-risk group compared with the low-risk group (P < 0.001). Every point in the CHA2DS2-VASc score was independently associated with 41% increase in stroke risk and 23% increase in mortality rate (for both P < 0.001).
The mortality rate and risk of stroke were strongly associated with the CHA2DS2-VASc scores. Hence, this scoring system could be useful to identify high-risk patients with no history of atrial fibrillation, in whom additional preventive measures might be beneficial to improve the outcome.
CHA2DS2-VASc评分广泛用于对非瓣膜性心房颤动患者的卒中风险进行分层。本研究的目的是评估CHA2DS2-VASc评分对于识别急性心肌梗死后且无心房颤动病史的个体中发生缺血性卒中和死亡的高风险患者是否有用。
我们分析了2003年至2008年间入住我们中心的连续性急性心肌梗死患者。根据CHA2DS2-VASc评分，分为四组：低风险（1分）、中风险（2 - 3分）、高风险（4 - 5分）和极高风险（>5分）。筛选长期随访数据以确定在远期观察期间发生卒中或死亡的患者。
在2980名登记参与者中，333名因心房颤动和/或正在接受口服抗凝治疗而被排除。最终，2647名个体纳入分析。在中位随访41.5个月期间，71名（2.68%）患者发生缺血性卒中，439名（16.58%）患者死亡。与低风险组相比，高风险组的卒中和死亡风险增加了四倍（P<0.001）。CHA2DS2-VASc评分的每一分均与卒中风险增加独立相关（增加41%）以及死亡率增加独立相关（增加23%）（两者P<0.001）。
死亡率和卒中风险与CHA2DS2-VASc评分密切相关。因此，该评分系统可能有助于识别无心房颤动病史的高风险患者，对于这些患者，额外的预防措施可能有利于改善预后。
