CHADS-VASc评分：无房颤的植入式监测装置患者血栓栓塞事件和死亡率的预测指标
CHADS-VASc Score: A Predictor of Thromboembolic Events and Mortality in Patients With an Implantable Monitoring Device Without Atrial Fibrillation.
作者信息
Parsons Christine, Patel Salma I, Cha Stephen, Shen Win-Kuang, Desai Santosh, Chamberlain Alanna M, Luis Sushil Allen, Aguilar Maria I, Demaerschalk Bart M, Mookadam Farouk, Shamoun Fadi
机构信息
Department of Medicine, Mayo Clinic, Scottsdale, AZ.
Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ.
出版信息
Mayo Clin Proc. 2017 Mar;92(3):360-369. doi: 10.1016/j.mayocp.2016.10.008.
OBJECTIVE
To determine if the CHADS-VASc score (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke or transient ischemic attack, vascular disease, age 65-74 years, sex category) predicts thromboembolism and death in patients without atrial fibrillation in a population with implantable cardiac monitoring devices.
PATIENTS AND METHODS
A retrospective review utilizing the Rochester Epidemiology Project research infrastructure was conducted to evaluate the CHADS-VASc tool as a predictor of mortality and ischemic stroke, transient ischemic attack, or systemic embolism in patients without atrial fibrillation. An implantable device was required in the inclusion criteria to discern the absence of atrial fibrillation. The study period was January 1, 2004, through March 7, 2016.
RESULTS
The study population (N=1606) had a mean (SD) age of 69.8 (12.6) years and median follow-up of 4.8 years (range, 0-12 years; quartile 1, 2.6 years and quartile 3, 8.1 years). The number of thromboembolic and mortality events stratified by CHADS-VASc score groupings of 0 to 2 (399 patients), 3 to 5 (756 patients), and 6 to 9 (451 patients) were 12 (3.0%), 109 (14.4%), and 123 (27.3%) and 22 (5.5%), 205 (27.1%), and 214 (47.4%), respectively. The CHADS-VASc score predicted thromboembolism and death. The hazard ratios (HRs) for thromboembolic events for CHADS-VASc scores 3 to 5 and 6 to 9 were 4.84 (95% CI, 2.66-8.80) and 10.53 (95% CI, 5.77-19.21) (reference group, scores 0-2). The HRs for death for the corresponding score categories were 4.45 (95% CI, 2.86-6.91) and 8.18 (95% CI, 5.23-12.78). The CHADS-VASc score also predicted development of atrial fibrillation, for which the HRs for scores 3 to 5 and 6 to 9 were 1.51 (95% CI, 1.13-2.00) and 2.17 (95% CI, 1.60-2.95).
CONCLUSION
The CHADS-VASc tool predicts thromboembolic events and overall mortality in patients without atrial fibrillation who have implantable devices.
目的
确定CHADS-VASc评分（充血性心力衰竭、高血压、年龄≥75岁、糖尿病、卒中或短暂性脑缺血发作、血管疾病、年龄65 - 74岁、性别分类）能否预测植入心脏监测设备人群中无房颤患者的血栓栓塞和死亡情况。
患者与方法
利用罗切斯特流行病学项目研究基础设施进行回顾性研究，以评估CHADS-VASc工具对无房颤患者死亡率及缺血性卒中、短暂性脑缺血发作或全身性栓塞的预测价值。纳入标准要求患者植入设备以明确无房颤。研究时间段为2004年1月1日至2016年3月7日。
结果
研究人群（N = 1606）的平均（标准差）年龄为69.8（12.6）岁，中位随访时间为4.8年（范围0 - 12年；四分位数1为2.6年，四分位数3为8.1年）。按CHADS-VASc评分分组为0至2分（399例患者）、3至5分（756例患者）和6至9分（451例患者）的血栓栓塞和死亡事件数量分别为12例（3.0%）、109例（14.4%）和123例（27.3%）以及22例（5.5%）、205例（27.1%）和214例（47.4%）。CHADS-VASc评分可预测血栓栓塞和死亡。CHADS-VASc评分为3至5分和6至9分时血栓栓塞事件的风险比（HR）分别为4.84（95%CI，2.66 - 8.80）和10.53（95%CI，5.77 - 19.21）（参照组，评分0 - 2分）。相应评分类别下死亡的HR分别为4.45（95%CI，2.86 - 6.91）和8.18（95%CI，5.23 - 12.78）。CHADS-VASc评分还可预测房颤发生，评分为3至5分和6至9分时的HR分别为1.51（95%CI，1.13 - 2.00）和2.17（95%CI，1.60 - 2.95）。
结论
CHADS-VASc工具可预测植入设备的无房颤患者的血栓栓塞事件和总体死亡率。
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