CHA2DS2-VASc 评分对伴有或不伴有心房颤动的腔隙性卒中患者预后预测的价值。
The Value of the CHADS and CHADS-VASc Score for Predicting the Prognosis in Lacunar Stroke with or without Atrial Fibrillation Patients.
机构信息
Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, P.R. China; Cardiovascular Research Institute, Wuhan University, Wuhan, P.R. China; Hubei Key Laboratory of Cardiology, Wuhan, P.R. China.
Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, P.R. China; Cardiovascular Research Institute, Wuhan University, Wuhan, P.R. China; Hubei Key Laboratory of Cardiology, Wuhan, P.R. China.
出版信息
J Stroke Cerebrovasc Dis. 2019 Nov;28(11):104143. doi: 10.1016/j.jstrokecerebrovasdis.2019.03.027. Epub 2019 Aug 30.
BACKGROUND
The CHADS and CHADS-VASc scoring systems have been proved efficacy to stratify stroke and thromboembolism risk in patients with atrial fibrillation (AF). Whether CHADS and CHADS-VASc score has predictive value for the prognosis in lacunar stroke (LS) patients remains unclear.
METHODS
A total of 763 consecutive patients with LS (mean age: 66 ± 12 years; 464 male) were enrolled in this study between January 2013 and December 2014. Patients were divided into LS without AF (LS; n = 679) and LS with AF (LS-AF; n = 84) groups. Measures of performance for the risk scores were evaluated at predicting mortality and restroke in LS-AF and LS without AF patients. All patients were evaluated with respect to clinical features and in-hospital clinical results.
RESULTS
During the mean follow-up period of 20 ± 5.8 months, 29 patients (3.8%) experienced all-cause death, 105 patients (13.8%) experienced recurrence of ischemic stroke. Multivariate analysis revealed that CHADS and CHADS-VASc score were independently associated with all-cause death (all P < .05). On receiver operating characteristic curve analysis, area under the curve (AUC) for CHADS2 score was .942 with a similar accuracy of the CHA2DS2-VASc score (AUC: .908) in predicting mortality in LS-AF patients. Kaplan-Meier curves were conducted according to the cut-off value of CHADS-VASc score. When CHADS score greater than or equal to 4 point or CHADS-VASc score greater than or equal to 5 point, the mortality in LS-AF patients was significantly higher compared with those CHADS score less than 4 point or CHADS-VASc score less than 5 point. However, after adjusting for clinical covariates, CHADS and CHADS-VASc score could not predict both mortality and restroke in LS without AF patients.
CONCLUSIONS
The CHADS and CHADS-VASc score have excellent predictive value for mortality in LS-AF patients but could not predict both mortality and restroke in LS without AF patients.
背景
CHADS 和 CHADS-VASc 评分系统已被证明可有效分层房颤（AF）患者的卒中及血栓栓塞风险。CHADS 和 CHADS-VASc 评分是否对腔隙性卒中（LS）患者的预后具有预测价值尚不清楚。
方法
本研究纳入 2013 年 1 月至 2014 年 12 月期间连续收治的 763 例 LS 患者（平均年龄：66±12 岁，464 例男性）。根据是否合并 AF 将患者分为 LS 无 AF（LS）组（n=679）和 LS 合并 AF（LS-AF）组（n=84）。评估风险评分对 LS-AF 和 LS 无 AF 患者死亡率和再发卒中的预测效能。所有患者均进行临床特征和住院临床结局评估。
结果
在平均 20±5.8 个月的随访期间，29 例（3.8%）患者发生全因死亡，105 例（13.8%）患者发生缺血性卒中再发。多变量分析显示，CHADS 和 CHADS-VASc 评分与全因死亡独立相关（均 P<.05）。在受试者工作特征曲线分析中，CHADS2 评分预测 LS-AF 患者死亡率的曲线下面积（AUC）为 0.942，CHA2DS2-VASc 评分的准确性相当（AUC：0.908）。根据 CHADS-VASc 评分的截断值绘制 Kaplan-Meier 曲线。当 CHADS 评分≥4 分或 CHADS-VASc 评分≥5 分时，LS-AF 患者的死亡率显著高于 CHADS 评分<4 分或 CHADS-VASc 评分<5 分的患者。然而，在校正临床协变量后，CHADS 和 CHADS-VASc 评分不能预测 LS 无 AF 患者的死亡率和再发卒中。
结论
CHADS 和 CHADS-VASc 评分对 LS-AF 患者的死亡率具有良好的预测价值，但不能预测 LS 无 AF 患者的死亡率和再发卒中。
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