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根据CHADS-VASc评分分类的癌症患者中，心房颤动对缺血性卒中发生的影响——一项全国性队列研究

Impact of atrial fibrillation on the development of ischemic stroke among cancer patients classified by CHADS-VASc score-a nationwide cohort study.

作者信息

Hu Wei-Syun, Lin Cheng-Li

机构信息

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.

出版信息

Oncotarget. 2018 Jan 10;9(7):7623-7630. doi: 10.18632/oncotarget.24143. eCollection 2018 Jan 26.

DOI:10.18632/oncotarget.24143
PMID:29484138
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5800930/
Abstract

PURPOSE

The current study aimed to explore the impact of atrial fibrillation (AF) on risk of ischemic stroke among cancer patients classified by CHADS-VASc score.

METHODS

Study participants were identified from Registry for Catastrophic Illness Patient Database. All cancer patients whether they had comorbid AF or not were divided into 4 groups according to their CHADS-VASc score-a score of 0-1, 2-3, 4-5 and >5. Competing risk analysis was used to evaluate the subhazard ratios (SHRs) and 95% confidence intervals (CIs) of incident ischemic stroke between cancer patients with and without AF according to their CHADS-VASc score.

RESULTS

A total of 781473 patients with cancer were identified. Of them, 21134 had comorbid AF whereas the remaining 760339 patients did not. After controlling for the confounding factors and the competing risk of death, among cancer patients, those with AF were associated with the highest risk of ischemic stroke than those without AF while their CHADS-VASc score was 0∼1 (adjusted SHR [aSHR] = 4.15, 95% CI = 3.29-5.23). Among those with a CHADS-VASc score of >5, the AF group exhibited a 1.82-fold higher risk of ischemic stroke than the non-AF group (95% CI = 1.34-2.47).

CONCLUSIONS

The impact of AF on risk of ischemic stroke was attenuated with advancing CHADS-VASc score in patients with cancer.

摘要

目的

本研究旨在探讨心房颤动（AF）对按CHADS-VASc评分分类的癌症患者缺血性卒中风险的影响。

方法

研究参与者来自重大疾病患者数据库登记处。所有癌症患者，无论是否合并AF，均根据其CHADS-VASc评分分为4组，评分分别为0-1、2-3、4-5和>5。采用竞争风险分析来评估合并AF和未合并AF的癌症患者根据其CHADS-VASc评分发生缺血性卒中的亚危险比（SHR）和95%置信区间（CI）。

结果

共识别出781473例癌症患者。其中，21134例合并AF，其余760339例未合并AF。在控制混杂因素和死亡的竞争风险后，在癌症患者中，CHADS-VASc评分为0∼1时，合并AF的患者缺血性卒中风险高于未合并AF的患者（调整后SHR[aSHR]=4.15，95%CI=3.29-5.23）。在CHADS-VASc评分>5的患者中，AF组缺血性卒中风险比非AF组高1.82倍（95%CI=1.34-2.47）。

结论

在癌症患者中，随着CHADS-VASc评分的升高，AF对缺血性卒中风险的影响减弱。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/22b9/5800930/624cf51daebd/oncotarget-09-7623-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/22b9/5800930/5ede8604f991/oncotarget-09-7623-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/22b9/5800930/624cf51daebd/oncotarget-09-7623-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/22b9/5800930/5ede8604f991/oncotarget-09-7623-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/22b9/5800930/624cf51daebd/oncotarget-09-7623-g002.jpg

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