Department of Internal Medicine C, Meir Medical Center, Kfar Saba, Israel.
Department of Cardiology, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Int J Cardiol. 2017 Oct 1;244:277-281. doi: 10.1016/j.ijcard.2017.06.057. Epub 2017 Jun 15.
The CHA2DS2-VASc score has been recommended for the assessment of thromboembolic risk in patients with atrial fibrillation. Data regarding the association between the pre-admission CHA2DS2-VASc score and the outcome of patients with stroke and TIA are scarce. We aimed to assess the predictive value of pre-admission CHA2DS2-VASc score for early risk stratification of patients with acute cerebrovascular event.
The study group consisted of 8309 patients (53% males, mean age of 70±13.3years) with acute stroke and TIA included in the prospective National Acute Stroke Israeli (NASIS) registry. The two-primary end-points were in-hospital mortality and severe disability at discharge. We divided the study population into 4 groups according to their pre-admission CHA2DS2-VASc score (0-1, 2-3, 4-5, >5).
Following a multivariate analysis odds ratios (OR) for all-cause mortality increased for CHA2DS2-VASc score >1 (OR=2.1 95% CI=1.2-3.6, OR=1.8 95% CI=1.1-3.2, OR=1.8 95% CI 1.1-3.3, for patients with CHA2DS2-VASc score of 2-3, 4-5 and >5, respectively, p<0.001). OR for severe disability (mRS 4-5) at discharge increased significantly in direct association with the CHA2DS2-VASc score (OR=1.55 95% CI=1.14-2.12, OR=2.42 95% CI=1.8-3.3, OR=3 95% CI 2.19-4.27, for patients with CHA2DS2-VASc score of 2-3, 4-5 and >5, respectively as compared with 0-1, p<0.001). Each 1-point increase in the CHA2DS2-VASc score was associated with a 21% increase in the risk for severe disability.
High-risk pre-admission CHA2DS2-VASc score among patients with acute cerebrovascular events is associated with higher in-hospital mortality and severe disability at discharge.
CHA2DS2-VASc 评分已被推荐用于评估房颤患者的血栓栓塞风险。关于入院前 CHA2DS2-VASc 评分与卒中和 TIA 患者结局之间的关系的数据很少。我们旨在评估入院前 CHA2DS2-VASc 评分对急性脑血管事件患者早期风险分层的预测价值。
研究组包括纳入前瞻性以色列急性卒中登记研究（NASIS）的 8309 例急性卒中和 TIA 患者（53%为男性，平均年龄 70±13.3 岁）。两个主要终点是住院期间死亡率和出院时严重残疾。我们根据入院前 CHA2DS2-VASc 评分（0-1、2-3、4-5、>5）将研究人群分为 4 组。
多变量分析显示，CHA2DS2-VASc 评分>1 的全因死亡率的比值比（OR）增加（OR=2.1，95%CI=1.2-3.6，OR=1.8，95%CI=1.1-3.2，OR=1.8，95%CI=1.1-3.3，分别适用于 CHA2DS2-VASc 评分 2-3、4-5 和>5 的患者，p<0.001）。出院时严重残疾（mRS 4-5）的 OR 与 CHA2DS2-VASc 评分呈显著正相关（OR=1.55，95%CI=1.14-2.12，OR=2.42，95%CI=1.8-3.3，OR=3，95%CI=2.19-4.27，分别适用于 CHA2DS2-VASc 评分 2-3、4-5 和>5 的患者，与 0-1 相比，p<0.001）。CHA2DS2-VASc 评分每增加 1 分，严重残疾的风险就增加 21%。
急性脑血管事件患者入院前高风险 CHA2DS2-VASc 评分与住院期间死亡率和出院时严重残疾相关。
