Institute of General Practice, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
Department of Neurology, Goethe-University, Schleusenweg 2-16, 60528, Frankfurt, Germany.
BMC Cardiovasc Disord. 2019 Apr 23;19(1):94. doi: 10.1186/s12872-019-1074-7.
Oral anticoagulants can cause potentially serious adverse events. Therefore, before prescribing oral anticoagulants for ischemic stroke prevention in patients with atrial fibrillation (AF), stroke risk assessment is required to identify patients that are likely to benefit from treatment. Current guidelines recommend the CHADS-VASc-score for stroke risk assessment. The CHADS-VASc-score is based on observational studies from different treatment settings and countries. As ischemic stroke risk differs by setting and region, the aim of this study is to estimate ischemic stroke risk (stratified by the CHADS-VASc-score) for a broadly representative population with AF from southern Germany and compare them to results from previous studies.
The study design is a retrospective cohort study on patients with atrial fibrillation based on secondary data. We calculated CHADS-VASc-score based on patient's diagnoses recorded in the year 2014 and assessed outcomes in 2015-2016. The primary outcome is hospitalization for ischemic stroke. The secondary outome is hospitalizations for any thromboembolic event, including ischemic stroke, transient ischemic attack, peripheral arterial embolism, pulmonary embolism, and mesenterial embolism. We estimated the incidence rates of the outcomes (and corresponding 95%-confidence intervals) stratified by CHADS-VASc-score.
The primary endpoint occurred in 961 of the 30,299 patients constituting the study population, resulting in a total incidence rate of 2.2 per 100 person-years. The secondary endpoint occurred in 1553 patients (3.6 per 100 person-years). Ischemic stroke rates stratified by the CHADS-VASc-score tended to be lower than those reported previously. Thromboembolic event rates stratified tended to be similar to those reported previously.
Our results show that the performance of the CHADS-VASc-score differs in the German population, as compared to internationally published data, with an overall trend towards lower risk of ischemic stroke in uncoagulated patients with AF. These results should not be practice changing, but they emphasize that stroke risk estimation in patients with atrial fibrillation should be further refined.
口服抗凝剂可能会导致严重的不良反应。因此，在为房颤（AF）患者预防缺血性卒中开具口服抗凝药物之前，需要进行卒中风险评估，以确定可能从治疗中获益的患者。目前的指南建议使用 CHADS-VASc 评分进行卒中风险评估。CHADS-VASc 评分基于不同治疗环境和国家的观察性研究。由于缺血性卒中风险因环境和地区而异，因此本研究的目的是评估来自德国南部的广泛代表性房颤人群的缺血性卒中风险（根据 CHADS-VASc 评分分层），并与之前的研究结果进行比较。
这是一项基于二次数据的房颤患者回顾性队列研究。我们根据患者在 2014 年记录的诊断计算 CHADS-VASc 评分，并在 2015-2016 年评估结果。主要结局是缺血性卒中住院。次要结局是任何血栓栓塞事件住院，包括缺血性卒中、短暂性脑缺血发作、外周动脉栓塞、肺栓塞和肠系膜栓塞。我们根据 CHADS-VASc 评分分层估计结局的发生率（和相应的 95%置信区间）。
在构成研究人群的 30299 名患者中，主要终点发生在 961 名患者中，总发生率为每 100 人年 2.2 例。次要终点发生在 1553 名患者中（每 100 人年 3.6 例）。根据 CHADS-VASc 评分分层的缺血性卒中发生率低于先前报告的发生率。根据 CHADS-VASc 评分分层的血栓栓塞事件发生率趋于与先前报告的发生率相似。
我们的结果表明，CHADS-VASc 评分在德国人群中的表现与国际发表的数据不同，与未经抗凝治疗的房颤患者的缺血性卒中风险总体呈下降趋势。这些结果不应改变实践，但它们强调了在房颤患者中进行卒中风险评估应进一步细化。
