Hu Wei-Syun, Lin Cheng-Li
School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan; Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, Taichung 40447, Taiwan.
Management Office for Health Data, China Medical University Hospital, Taichung 40447, Taiwan.
J Clin Neurosci. 2017 Nov;45:193-198. doi: 10.1016/j.jocn.2017.06.007. Epub 2017 Jul 3.
The current study sought to evaluate the accuracy of CHADS-VASc score for ischemic stroke prediction in patients with mesenteric ischemia without atrial fibrillation (AF).
The study participants included patients aged ≥18years with a new diagnosis of mesenteric ischemia during hospitalization between January 1, 2000 and December 31, 2011. Individuals with atrial fibrillation (AF) or atrial flutter during the study period were excluded. The study participants were followed up until the ischemic stroke appeared or they were censored due to withdrawal from this program, mortality, or the end of the study period, whichever came first. Cox proportional hazards regression models were applied for ischemic stroke risk stratification in the study participants by CHADS-VASc score. The c-statistic based on the receiver operating characteristic (ROC) analysis was applied to investigate the accuracy of CHADS-VASc score for ischemic stroke risk discrimination.
A total of 24039 study participants were enrolled. Ischemic stroke incidence increased from 1.54% in CHADS-VASc score of 0 to 9.23% in CHADS-VASc score of 6 or more. Moreover, the Kaplan-Meier curve with a log rank test demonstrated that patients with a higher CHADS-VASc score were associated with an increased cumulative incidence rate of ischemic stroke during the follow-up period (p<0.001). The discriminatory performance of the CHA2DS2-VASc score resulted in C-statistics of 0.65(95% CI=0.63-0.66) for predicting ischemic stroke risk among patients with mesenteric ischemia without AF.
A higher CHADS-VASc score is demonstrated to be associated with an increased risk of ischemic stroke among patients with mesenteric ischemia without comorbid AF.
本研究旨在评估CHADS-VASc评分对无房颤（AF）的肠系膜缺血患者缺血性卒中预测的准确性。
研究参与者包括2000年1月1日至2011年12月31日住院期间新诊断为肠系膜缺血的≥18岁患者。排除研究期间患有房颤（AF）或心房扑动的个体。对研究参与者进行随访，直至出现缺血性卒中，或因退出本项目、死亡或研究期结束（以先发生者为准）而被截尾。通过CHADS-VASc评分，将Cox比例风险回归模型应用于研究参与者的缺血性卒中风险分层。基于受试者工作特征（ROC）分析的c统计量用于研究CHADS-VASc评分对缺血性卒中风险辨别的准确性。
共纳入24039名研究参与者。缺血性卒中发生率从CHADS-VASc评分为0时的1.54%增加到CHADS-VASc评分为6或更高时的9.23%。此外，采用对数秩检验的Kaplan-Meier曲线表明，CHADS-VASc评分较高的患者在随访期间缺血性卒中的累积发生率增加（p<0.001）。CHA2DS2-VASc评分的鉴别性能在预测无AF的肠系膜缺血患者的缺血性卒中风险时，c统计量为0.65（95%CI=0.63-0.66）。
在无合并AF的肠系膜缺血患者中，较高的CHADS-VASc评分与缺血性卒中风险增加相关。
