心房颤动患者的长期卒中风险预测：ABC-卒中与CHADS-VASc评分的比较
Long-Term Stroke Risk Prediction in Patients With Atrial Fibrillation: Comparison of the ABC-Stroke and CHADS-VASc Scores.
作者信息
Rivera-Caravaca José Miguel, Roldán Vanessa, Esteve-Pastor María Asunción, Valdés Mariano, Vicente Vicente, Lip Gregory Y H, Marín Francisco
机构信息
Department of Hematology and Clinical Oncology, Hospital General Universitario Morales Meseguer, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), University of Murcia, Spain.
Department of Hematology and Clinical Oncology, Hospital General Universitario Morales Meseguer, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), University of Murcia, Spain
出版信息
J Am Heart Assoc. 2017 Jul 20;6(7):e006490. doi: 10.1161/JAHA.117.006490.
BACKGROUND
The ABC-stroke score (age, biomarkers [N-terminal fragment B-type natriuretic peptide, high-sensitivity troponin], and clinical history [prior stroke/transient ischemic attack]) was proposed to predict stroke in atrial fibrillation (AF). This score was derived/validated in 2 clinical trial cohorts in which patients with AF were highly selected and carefully followed-up. However, the median follow-up was 1.9 years in the trial cohort; therefore, its long-term predictive performance remains uncertain. This study aimed to compare the long-term predictive performances of the ABC-stroke and CHADS-VASc (cardiac failure or dysfunction, hypertension, age ≥75 [doubled], diabetes mellitus, stroke [doubled]-vascular disease, age 65 to 74 years and sex category [female]) scores in a cohort of anticoagulated patients with AF.
METHODS AND RESULTS
We recruited 1125 consecutive patients with AF who were stable on vitamin K antagonists and followed-up for a median of 6.5 years. ABC-stroke and CHADS-VASc (cardiac failure or dysfunction, hypertension, age ≥75 [doubled], diabetes mellitus, stroke [doubled]-vascular disease, age 65 to 74 years and sex category [female]) scores were calculated and compared. Median CHADS-VASc and ABC-stroke scores were 4 (interquartile range 3-5) and 9.1 (interquartile range 7.3-11.3), respectively. There were 114 ischemic strokes (1.55% per year) at 6.5 years. The C-index of ABC-stroke at 3.5 years was significantly higher than CHADS-VASc (0.663 versus 0.600, =0.046), but both C-indexes were nonsignificantly different at 6.5 years. Integrated discrimination improvement showed a small improvement (<2%) in sensitivity at 3.5 and 6.5 years with ABC-stroke. For ABC-stroke, net reclassification improvement was nonsignificantly different at 3.5 years, and showed a negative reclassification at 6.5 years compared with CHADS-VASc. Decision curve analyses did not show a marked improvement in clinical usefulness of the ABC-stroke score over the CHADS-VASc score.
CONCLUSIONS
In anticoagulated patients with AF followed-up over a long-term period, the novel ABC-stroke score does not offer significantly better predictive performance compared with the CHADS-VASc score.
背景
ABC 卒中评分（年龄、生物标志物[N 末端 B 型利钠肽片段、高敏肌钙蛋白]以及临床病史[既往卒中/短暂性脑缺血发作]）旨在预测心房颤动（AF）患者发生卒中的风险。该评分是在 2 个临床试验队列中得出并验证的，其中入选的 AF 患者均经过严格筛选且随访仔细。然而，试验队列中的中位随访时间为 1.9 年；因此，其长期预测性能仍不确定。本研究旨在比较 ABC 卒中和 CHADS-VASc（心力衰竭或功能障碍、高血压、年龄≥75 岁[加倍]、糖尿病、卒中[加倍] - 血管疾病、年龄 65 至 74 岁以及性别类别[女性]）评分在一组接受抗凝治疗的 AF 患者中的长期预测性能。
方法与结果
我们连续招募了 1125 例服用维生素 K 拮抗剂病情稳定的 AF 患者，并进行了中位时间为 6.5 年的随访。计算并比较了 ABC 卒中和 CHADS-VASc 评分（心力衰竭或功能障碍、高血压、年龄≥75 岁[加倍]、糖尿病、卒中[加倍] - 血管疾病、年龄 65 至 74 岁以及性别类别[女性]）。CHADS-VASc 评分和 ABC 卒中评分的中位数分别为 4（四分位间距 3 - 5）和 9.1（四分位间距 7.3 - 11.3）。在 6.5 年时发生了 114 例缺血性卒中（每年 1.55%）。ABC 卒中评分在 3.5 年时的 C 指数显著高于 CHADS-VASc（0.663 对 0.600，P = 0.046），但在 6.5 年时两者的 C 指数差异无统计学意义。综合判别改善显示，ABC 卒中评分在 3.5 年和 6.5 年时敏感性有小幅改善（<2%）。对于 ABC 卒中评分，净重新分类改善在 3.5 年时差异无统计学意义，与 CHADS-VASc 评分相比，在 6.5 年时显示为负向重新分类。决策曲线分析未显示 ABC 卒中评分在临床实用性方面比 CHADS-VASc 评分有显著改善。
结论
在长期随访的接受抗凝治疗的 AF 患者中，与 CHADS-VASc 评分相比，新的 ABC 卒中评分并未提供显著更好的预测性能。
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