Bisson Arnaud, Bodin Alexandre, Clementy Nicolas, Babuty Dominique, Lip Gregory Y H, Fauchier Laurent
Service de Cardiologie, Pôle Cœur Thorax Vasculaire, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France.
University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, B18 7QH, United Kingdom.
Am J Cardiol. 2018 Feb 15;121(4):437-444. doi: 10.1016/j.amjcard.2017.11.016. Epub 2017 Dec 2.
The CHADS-VASc score may identify patients at higher risk of atrial fibrillation (AF) following ischemic stroke (IS) in patients without known AF. We compared gender-related differences in items from CHADS-VASc score and their relation with AF occurrence after IS. This French cohort study was based on the database covering hospital care from 2009 to 2012 for the entire population. Of 336,291 patients with IS, 240,459 (71.5%) had no AF at baseline. Women were older, more frequently had hypertension, heart failure, and had a higher CHADS-VASc score than men (4.63 vs 4.39, p<2DS-VASc score items were independent predictors of incident AF, except diabetes and vascular disease). Results were mostly similar in men and women when one analyzed separately these predictors. Predictive value of the CHADS-VASc score for identifying patients at higher risk of incident AF was somewhat higher in men (C statistic 0.720, 95% confidence interval 0.717 to 0.722) than in women (0.702, 95% confidence interval 0.699 to 0.704). Coronary artery disease, valvular disease, and history of pacemaker or defibrillator implantation were also independent predictors of incident AF. In conclusion, there were significant differences in co-morbidities, possible mechanisms, incidence, and predictors of AF between men and women after IS. However, a strategy using CHADS-VASc score for identifying a higher risk of incident AF following IS was useful in both genders.
CHADS-VASc评分可能有助于识别无房颤病史的缺血性卒中（IS）患者发生房颤（AF）的高风险人群。我们比较了CHADS-VASc评分各项指标的性别差异及其与IS后房颤发生的关系。这项法国队列研究基于2009年至2012年覆盖全体人群医院护理情况的数据库。在336,291例IS患者中，240,459例（71.5%）基线时无房颤。女性年龄更大，高血压、心力衰竭的发生率更高，CHADS-VASc评分高于男性（4.63对4.39，p<2DS-VASc评分指标是房颤发生的独立预测因素，糖尿病和血管疾病除外）。分别分析这些预测因素时，男性和女性的结果大多相似。CHADS-VASc评分识别房颤发生高风险患者的预测价值在男性中（C统计量0.720，95%置信区间0.717至0.722）略高于女性（0.702，95%置信区间0.699至0.704）。冠状动脉疾病、瓣膜疾病以及起搏器或除颤器植入史也是房颤发生的独立预测因素。总之，IS后男性和女性在合并症、可能机制、发病率及房颤预测因素方面存在显著差异。然而，使用CHADS-VASc评分策略识别IS后房颤发生高风险在两性中均有用。
