CHA2 DS2 VASc评分作为非房颤门诊患者心血管事件的预测指标
CHA2 DS2 VASc Score as a Predictor of Cardiovascular Events in Ambulatory Patients without Atrial Fibrillation.
作者信息
Polenz Gustavo Freb, Leiria Tiago Luiz Luz, Essebag Vidal, Kruse Marcelo Lapa, Pires Leonardo Martins, Nogueira Thaize Brisolara, Guimarães Raphael Boesche, Santanna Roberto Tofani, DE Lima Gustavo Glotz
机构信息
Electrophysiology Department of the Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia, Porto Alegre, Rio Grande do Sul, Brazil.
Cardiac Electrophysiology, McGill University Health Centre, Montreal, Québec, Canada.
出版信息
Pacing Clin Electrophysiol. 2015 Dec;38(12):1412-7. doi: 10.1111/pace.12744. Epub 2015 Sep 28.
BACKGROUND
New evidence suggests that the CHA(2)DS(2)VASc (congestive heart failure, hypertension [HTN], age, diabetes, stroke, vascular disease, and female gender) score may be a reliable tool to predict the risk of thromboembolic events in patients without documented atrial fibrillation (AF).
METHODS
We performed a prospective cohort study of outpatients without AF or flutter, who were not using oral anticoagulation. Clinical characteristics were assessed and patients were stratified according to the CHA(2)DS(2)VASc score. We evaluated the incidence of major adverse cardiac outcomes and its relation to the CHA(2)DS(2)VASc score during the follow-up.
RESULTS
Four hundred sixty-eight patients without AF were enrolled with a mean follow-up of 12 ± 6 months. Age was 64.9 ± 11.3 years. The prevalence of HTN was 88.4%, diabetes 37.6%, heart failure 26.3%, and vascular disease 61.7%. Overall, CHA(2)DS(2)VASc score was 3.4 ± 1.4. There were 15 major adverse cardiac outcomes during 12.2 months of follow-up (overall incidence of 3.2 per 100 person-years). We found significant differences in relation to gender, age, previous stroke, and follow-up length in patients with and without adverse outcomes. The CHA(2)DS(2)VASc score was higher in those with adverse outcomes (4.2 ± 1.7 vs 3.4 ± 1.4; P = 0.035). Patients with a CHA(2)DS(2)VASc ≥6 had a relative risk for adverse outcomes of 4.2 (95% confidence interval: 1.27-13.90).
CONCLUSIONS
In our population, CHA(2)DS(2)VASc score predicts major adverse cardiac outcomes, including stroke and death, in a cohort of patients without AF.
背景
新证据表明，CHA(2)DS(2)VASc（充血性心力衰竭、高血压[HTN]、年龄、糖尿病、卒中、血管疾病和女性性别）评分可能是预测无房颤（AF）记录患者血栓栓塞事件风险的可靠工具。
方法
我们对未使用口服抗凝药的非AF或扑动门诊患者进行了一项前瞻性队列研究。评估临床特征，并根据CHA(2)DS(2)VASc评分对患者进行分层。我们在随访期间评估了主要不良心脏事件的发生率及其与CHA(2)DS(2)VASc评分的关系。
结果
纳入468例无AF患者，平均随访12±6个月。年龄为64.9±11.3岁。HTN患病率为88.4%，糖尿病为37.6%，心力衰竭为26.3%，血管疾病为61.7%。总体而言，CHA(2)DS(2)VASc评分为3.4±1.4。在12.2个月的随访期间有15例主要不良心脏事件（总发生率为每100人年3.2例）。我们发现有和无不良事件的患者在性别、年龄、既往卒中及随访时长方面存在显著差异。有不良事件患者的CHA(2)DS(2)VASc评分更高（4.2±1.7对3.4±1.4；P=0.035）。CHA(2)DS(2)VASc≥6的患者不良事件相对风险为4.2（95%置信区间：1.27 - 13.90）。
结论
在我们的研究人群中，CHA(2)DS(2)VASc评分可预测无AF患者队列中的主要不良心脏事件，包括卒中和死亡。
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