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心房颤动患者卒中前CHADS-VASc评分与急性卒中严重程度：RAF研究结果

Prestroke CHADS-VASc Score and Severity of Acute Stroke in Patients with Atrial Fibrillation: Findings from RAF Study.

作者信息

Acciarresi Monica, Paciaroni Maurizio, Agnelli Giancarlo, Falocci Nicola, Caso Valeria, Becattini Cecilia, Marcheselli Simona, Rueckert Christina, Pezzini Alessandro, Morotti Andrea, Costa Paolo, Padovani Alessandro, Csiba Laszló, Szabó Lilla, Sohn Sung-Il, Tassinari Tiziana, Abdul-Rahim Azmil H, Michel Patrik, Cordier Maria, Vanacker Peter, Remillard Suzette, Alberti Andrea, Venti Michele, D'Amore Cataldo, Scoditti Umberto, Denti Licia, Orlandi Giovanni, Chiti Alberto, Gialdini Gino, Bovi Paolo, Carletti Monica, Rigatelli Alberto, Putaala Jukka, Tatlisumak Turgut, Masotti Luca, Lorenzini Gianni, Tassi Rossana, Guideri Francesca, Martini Giuseppe, Tsivgoulis Georgios, Vadikolias Kostantinos, Liantinioti Chrissoula, Corea Francesco, Del Sette Massimo, Ageno Walter, De Lodovici Maria Luisa, Bono Giorgio, Baldi Antonio, D'Anna Sebastiano, Sacco Simona, Carolei Antonio, Tiseo Cindy, Imberti Davide, Zabzuni Dorjan, Doronin Boris, Volodina Vera, Consoli Domenico, Galati Franco, Pieroni Alessio, Toni Danilo, Monaco Serena, Baronello Mario Maimone, Barlinn Kristian, Pallesen Lars-Peder, Kepplinger Jessica, Bodechtel Ulf, Gerber Johannes, Deleu Dirk, Melikyan Gayane, Ibrahim Faisal, Akhtar Naveed, Mosconi Maria Giulia, Lees Kennedy R

机构信息

Stroke Unit and Division of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy.

出版信息

J Stroke Cerebrovasc Dis. 2017 Jun;26(6):1363-1368. doi: 10.1016/j.jstrokecerebrovasdis.2017.02.011. Epub 2017 Feb 22.

DOI:10.1016/j.jstrokecerebrovasdis.2017.02.011

PMID:28236595

Abstract

BACKGROUND AND PURPOSE

The aim of this study was to investigate for a possible association between both prestroke CHADS-VASc score and the severity of stroke at presentation, as well as disability and mortality at 90 days, in patients with acute stroke and atrial fibrillation (AF).

METHODS

This prospective study enrolled consecutive patients with acute ischemic stroke, AF, and assessment of prestroke CHADS-VASc score. Severity of stroke was assessed on admission using the National Institutes of Health Stroke Scale (NIHSS) score (severe stroke: NIHSS ≥10). Disability and mortality at 90 days were assessed by the modified Rankin Scale (mRS <3 or ≥3). Multiple logistic regression was used to correlate prestroke CHADS-VASc and severity of stroke, as well as disability and mortality at 90 days.

RESULTS

Of the 1020 patients included in the analysis, 606 patients had an admission NIHSS score lower and 414 patients higher than 10. At 90 days, 510 patients had mRS ≥3. A linear correlation was found between the prestroke CHADS-VASc score and severity of stroke (P = .001). On multivariate analysis, CHADS-VASc score correlated with severity of stroke (P = .041) and adverse functional outcome (mRS ≥3) (P = .001). A logistic regression with the receiver operating characteristic graph procedure (C-statistics) evidenced an area under the curve of .60 (P = .0001) for severe stroke. Furthermore, a correlation was found between prestroke CHADS-VASc score and lesion size.

CONCLUSIONS

In patients with AF, in addition to the risk of stroke, a high CHADS-VASc score was independently associated with both stroke severity at onset and disability and mortality at 90 days.

摘要

背景与目的

本研究旨在调查急性脑卒中合并心房颤动（AF）患者的卒中前CHADS-VASc评分与就诊时卒中严重程度、90天时的残疾及死亡率之间可能存在的关联。

方法

这项前瞻性研究纳入了连续的急性缺血性脑卒中、AF患者，并对其卒中前CHADS-VASc评分进行评估。入院时使用美国国立卫生研究院卒中量表（NIHSS）评分评估卒中严重程度（重度卒中：NIHSS≥10）。90天时的残疾和死亡率通过改良Rankin量表（mRS<3或≥3）进行评估。采用多因素逻辑回归分析卒中前CHADS-VASc评分与卒中严重程度、90天时的残疾及死亡率之间的相关性。

结果

纳入分析的1020例患者中，606例患者入院时NIHSS评分低于10，414例患者高于10。90天时，510例患者mRS≥3。发现卒中前CHADS-VASc评分与卒中严重程度之间存在线性相关性（P = 0.001）。多因素分析显示，CHADS-VASc评分与卒中严重程度（P = 0.041）及不良功能结局（mRS≥3）（P = 0.001）相关。采用受试者工作特征曲线程序（C统计量）进行的逻辑回归分析显示，重度卒中的曲线下面积为0.60（P = 0.0001）。此外，还发现卒中前CHADS-VASc评分与病变大小之间存在相关性。