非瓣膜性心房颤动的缺血性中风或短暂性脑缺血发作患者入院前风险评分与两年临床结局之间的关联
Associations between Pre-Admission Risk Scores and Two-Year Clinical Outcomes in Ischemic Stroke or Transient Ischemic Attack Patients with Non-Valvular Atrial Fibrillation.
作者信息
Tokunaga Keisuke, Yamagami Hiroshi, Koga Masatoshi, Todo Kenichi, Kimura Kazumi, Itabashi Ryo, Terasaki Tadashi, Shiokawa Yoshiaki, Kamiyama Kenji, Takizawa Shunya, Okuda Satoshi, Okada Yasushi, Kameda Tomoaki, Nagakane Yoshinari, Hasegawa Yasuhiro, Shibuya Satoshi, Ito Yasuhiro, Matsuoka Hideki, Takamatsu Kazuhiro, Nishiyama Kazutoshi, Kario Kazuomi, Yagita Yoshiki, Kitazono Takanari, Kinoshita Naoto, Takasugi Junji, Okata Takuya, Yoshimura Sohei, Sato Shoichiro, Arihiro Shoji, Toyoda Kazunori
机构信息
Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Japan.
出版信息
Cerebrovasc Dis. 2018;45(3-4):170-179. doi: 10.1159/000487896. Epub 2018 Mar 29.
BACKGROUND
We aimed to clarify associations between pre-admission risk scores (CHADS2, CHA2DS2-VASc, and HAS-BLED) and 2-year clinical outcomes in ischemic stroke or transient ischemic attack (TIA) patients with non-valvular atrial fibrillation (NVAF) using a prospective, multicenter, observational registry.
METHODS
From 18 Japanese stroke centers, ischemic stroke or TIA patients with NVAF hospitalized within 7 days after onset were enrolled. Outcome measures were defined as death/disability (modified Rankin Scale score ≥3) at 2 years, 2-year mortality, and ischemic or hemorrhagic events within 2 years.
RESULTS
A total of 1,192 patients with NVAF (527 women; mean age, 78 ± 10 years), including 1,141 ischemic stroke and 51 TIA, were analyzed. Rates of death/disability, mortality, and ischemic or hemorrhagic events increased significantly with increasing pre-admission CHADS2 (p for trend <0.001 for death/disability and mortality, p for trend = 0.024 for events), CHA2DS2-VASc (p for trend <0.001 for all), and HAS-BLED (p for trend = 0.004 for death/disability, p for trend <0.001 for mortality, p for trend = 0.024 for events) scores. Pre-admission CHADS2 (OR per 1 point, 1.52; 95% CI 1.35-1.71; p <0.001 for death/disability; hazard ratio (HR) per 1 point, 1.23; 95% CI 1.12-1.35; p <0.001 for mortality; HR per 1 point, 1.14; 95% CI 1.02-1.26; p = 0.016 for events), CHA2DS2-VASc (1.55, 1.41-1.72, p < 0.001; 1.21, 1.12-1.30, p < 0.001; 1.17, 1.07-1.27, p < 0.001; respectively), and HAS-BLED (1.33, 1.17-1.52, p < 0.001; 1.23, 1.10-1.38, p < 0.001; 1.18, 1.05-1.34, p = 0.008; respectively) scores were independently associated with all outcome measures.
CONCLUSIONS
In ischemic stroke or TIA patients with NVAF, all pre-admission risk scores were independently associated with death/disability at 2 years and 2-year mortality, as well as ischemic or hemorrhagic events within 2 years.
背景
我们旨在通过一项前瞻性、多中心、观察性登记研究，阐明非瓣膜性心房颤动（NVAF）的缺血性卒中或短暂性脑缺血发作（TIA）患者入院前风险评分（CHADS2、CHA2DS2-VASc和HAS-BLED）与2年临床结局之间的关联。
方法
从18家日本卒中中心招募发病后7天内住院的NVAF缺血性卒中或TIA患者。结局指标定义为2年时的死亡/残疾（改良Rankin量表评分≥3）、2年死亡率以及2年内的缺血性或出血性事件。
结果
共分析了1192例NVAF患者（527例女性；平均年龄78±10岁），其中包括1141例缺血性卒中和51例TIA。随着入院前CHADS2（死亡/残疾和死亡率的趋势p<0.001，事件的趋势p = 0.024）、CHA2DS2-VASc（所有趋势p<0.001）和HAS-BLED（死亡/残疾的趋势p = 0.004，死亡率的趋势p<0.001，事件的趋势p = 0.024）评分的增加，死亡/残疾、死亡率以及缺血性或出血性事件的发生率显著增加。入院前CHADS2（死亡/残疾每增加1分的比值比（OR）为1.52；95%置信区间（CI）为1.35-1.71；p<0.001；死亡率每增加1分的风险比（HR）为1.23；95%CI为1.12-1.35；p<0.001；事件每增加1分的HR为1.14；95%CI为1.02-1.26；p = 0.016）、CHA2DS2-VASc（分别为1.55，1.41-1.72，p<0.001；1.21，1.12-1.30，p<0.001；1.17，1.07-1.27，p<0.001）和HAS-BLED（分别为1.33，1.17-1.52，p<0.001；1.23，1.10-1.38，p<0.001；1.18，1.05-1.34，p = 0.008）评分均与所有结局指标独立相关。
结论
在NVAF的缺血性卒中或TIA患者中，所有入院前风险评分均与2年时的死亡/残疾、2年死亡率以及2年内的缺血性或出血性事件独立相关。
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