Institute of Cardiology, Department of Neuroscience, Imaging and Clinical Sciences, and Center of Excellence on Aging, CeSI-Met, G. d'Annunzio University, Chieti-Pescara, Italy.
Institute of Advanced Biomedical Technologies, G. d'Annunzio University, Chieti-Pescara, Italy.
Eur J Prev Cardiol. 2019 Dec;26(18):1987-1997. doi: 10.1177/2047487319868320. Epub 2019 Aug 14.
The CHADSVASc score is used to evaluate the risk of thromboembolic events in patients with non-valvular atrial fibrillation. We assessed the prognostic yield of CHADSVASc for new-onset atrial fibrillation, cardiovascular morbidity and mortality in a non-atrial fibrillation population.
We analysed a population-based cohort of 22,179 middle-aged individuals with ( = 3542) and without ( = 18,367) a history of atrial fibrillation; we grouped the population into five CHADSVASc strata (0-1-2-3-≥4), and compared the risk of major adverse cerebro-cardiovascular events and mortality. Furthermore, we analysed the annual incidence of atrial fibrillation across different CHADSVASc strata.
Over a median follow-up of 15 years, 1572 patients (6.9%) had ischaemic strokes, 2162 (9.5%) coronary events and 5899 (26%) died. The cumulative incidence of ischaemic stroke in CHADSVASc ≥ 4 subjects without atrial fibrillation was similar to patients with atrial fibrillation and CHADSVASc 2, with a 10-year crude incidence rate of 0.91 (95% confidence interval (CI) 0.68-1.19) and 1.13 (95% CI 0.93-1.36) ischaemic strokes per 100 patient-years, respectively. CHADSVASc in a non-atrial fibrillation population showed higher predictive accuracy for ischaemic stroke compared with an atrial fibrillation population (area under the curve 0.60 vs. 0.56; = 0.001). In multivariable Cox regression analysis, CHADSVASc ≥ 2 was an independent predictor of all-cause death (adjusted hazard ratio (aHR) 2.58; 95% CI 2.42-2.76), cardiovascular death (aHR 3.40; 95% CI 2.98-3.89), ischaemic stroke (aHR 2.20; 95% CI 1.92-2.53) and coronary events (aHR 1.83; 95% CI 1.63-2.04). The cumulative incidence of atrial fibrillation was greater with increasing CHADSVASc strata, with an absolute annual incidence of more than 2% per year if CHADSVASc ≥ 4.
The CHADSVASc score is a sensitive tool for predicting new-onset atrial fibrillation and adverse outcomes in subjects both with and without atrial fibrillation.
CHADSVASc 评分用于评估非瓣膜性心房颤动患者发生血栓栓塞事件的风险。我们评估了 CHADSVASc 评分对非心房颤动人群中新发心房颤动、心血管发病率和死亡率的预后价值。
我们分析了一个基于人群的 22179 名中年个体的队列，其中（ = 3542 人）有和（ = 18367 人）无心房颤动病史；我们将人群分为五个 CHADSVASc 分层（0-1-2-3-≥4），比较主要不良心脑血管事件和死亡率的风险。此外，我们分析了不同 CHADSVASc 分层中心房颤动的年发生率。
在中位随访 15 年期间，1572 名患者（6.9%）发生缺血性卒中，2162 名（9.5%）发生冠状动脉事件，5899 名（26%）死亡。无心房颤动的 CHADSVASc≥4 患者的缺血性卒中累积发生率与 CHADSVASc 为 2 的心房颤动患者相似，10 年粗发生率分别为 0.91（95%置信区间 [CI] 0.68-1.19）和 1.13（95% CI 0.93-1.36）缺血性卒中/100 患者年。非心房颤动人群的 CHADSVASc 对缺血性卒中的预测准确性高于心房颤动人群（曲线下面积 0.60 比 0.56； = 0.001）。在多变量 Cox 回归分析中，CHADSVASc≥2 是全因死亡（校正后的危险比[aHR] 2.58；95% CI 2.42-2.76）、心血管死亡（aHR 3.40；95% CI 2.98-3.89）、缺血性卒中（aHR 2.20；95% CI 1.92-2.53）和冠状动脉事件（aHR 1.83；95% CI 1.63-2.04）的独立预测因素。随着 CHADSVASc 分层的增加，心房颤动的累积发生率增加，如果 CHADSVASc≥4，则每年绝对发生率超过 2%。
CHADSVASc 评分是预测有和无心房颤动患者新发心房颤动和不良结局的敏感工具。
