Gutierrez Alejandra, Patell Rushad, Rybicki Lisa, Khorana Alok A
Department of Cardiovascular Medicine, University of Minnesota, Minneapolis, MN, USA.
Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Ther Adv Cardiovasc Dis. 2019 Jan-Dec;13:1753944719860676. doi: 10.1177/1753944719860676.
The role of cancer-specific factors for ischemic stroke and mortality in patients with cancer and atrial fibrillation (AF) is unknown. We evaluated the utility of a previously validated risk tool for venous thromboembolism (VTE) in cancer outpatients [Khorana score (KS)] in predicting stroke and mortality in cancer patients with AF.
We conducted a retrospective cohort study of patients with cancer and AF at the Cleveland Clinic from 2008 to 2014. Outcomes, CHADS2, CHA2DS2-VASc, and KS scores were calculated from date of cancer diagnosis. Prognostic factors were identified with Fine and Gray regression (for stroke) or Cox proportional hazards analysis (for mortality).
The study population comprised 1181 patients. Genitourinary (19%), lung (18%), and gastrointestinal (13%) were the most frequent cancers. Overall, 67% had CHADS2 ⩾ 2, 57% had an intermediate KS (1-2), and 7% high KS (⩾3). Median follow up was 26.5 months (range 0.03-76). At a median of 8.2 months (range 0-61), 45 patients (3.8%) developed a stroke and 418 (35%) died. In multivariable analysis a high KS (HR 4.5, 95% CI 3.2-6.3, < 0.001) was associated with a quadruple risk of death and every point increase in CHADS2 score had a 20% increased risk of death (HR 1.19, 95% CI 1.1-1.2, < 0.001). The addition of KS did not improve risk stratification for ischemic stroke to CHADS2.
In patients with cancer and AF, CHADS2 and CHA2DS2-VASc but not KS were predictive of ischemic stroke. A high KS represented a unique predictor of mortality beyond traditional risk scores.
癌症特异性因素在患有癌症和心房颤动（AF）的患者发生缺血性卒中和死亡方面所起的作用尚不清楚。我们评估了一种先前经验证的用于预测癌症门诊患者静脉血栓栓塞（VTE）的风险工具[科纳纳评分（KS）]在预测患有AF的癌症患者发生卒中和死亡方面的效用。
我们对2008年至2014年在克利夫兰诊所的患有癌症和AF的患者进行了一项回顾性队列研究。从癌症诊断日期计算结局、CHADS2、CHA2DS2-VASc和KS评分。通过Fine和Gray回归（用于卒中）或Cox比例风险分析（用于死亡率）确定预后因素。
研究人群包括1181例患者。泌尿生殖系统（19%）、肺部（18%）和胃肠道（13%）是最常见的癌症类型。总体而言，67%的患者CHADS2⩾2，57%的患者KS为中等（1 - 2），7%的患者KS高（⩾3）。中位随访时间为26.5个月（范围0.03 - 76个月）。在中位时间8.2个月（范围0 - 61个月）时，45例患者（3.8%）发生了卒中，418例患者（35%）死亡。在多变量分析中，高KS（风险比4.5，95%置信区间3.2 - 6.3，P<0.001）与死亡风险增加四倍相关，CHADS2评分每增加1分，死亡风险增加20%（风险比1.19，95%置信区间1.1 - 1.2，P<0.001）。将KS加入CHADS2中并未改善缺血性卒中的风险分层。
在患有癌症和AF的患者中，CHADS2和CHA2DS2-VASc可预测缺血性卒中，但KS不能。高KS是传统风险评分之外的一种独特的死亡预测因素。
