心房颤动合并脑淀粉样血管病影像学证据患者中 HAS-BLED 和 CHADS-VASc 评分的效用。
Utility of HAS-BLED and CHADS-VASc Scores Among Patients With Atrial Fibrillation and Imaging Evidence of Cerebral Amyloid Angiopathy.
机构信息
Division of Internal Medicine, Mayo Clinic, Rochester, MN.
Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN.
出版信息
Mayo Clin Proc. 2020 Oct;95(10):2090-2098. doi: 10.1016/j.mayocp.2020.03.034. Epub 2020 Aug 20.
OBJECTIVE
To determine the utility of the HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly, Drugs/alcohol concomitantly) and CHADS-VASc (Congestive heart failure, Hypertension, Age, Diabetes, previous Stroke/transient ischemic attack-VAScular disease) scores among patients on anticoagulation (AC) therapy for atrial fibrillation (AF) who have evidence of cerebral amyloid angiopathy (CAA).
PATIENTS AND METHODS
Patients older than 55 years with a diagnosis of AF who had a nontraumatic intracerebral hemorrhage (ICH) while on AC therapy between 1995 and 2016 were identified using the Rochester Epidemiology Project Database. Medical records were reviewed, including imaging of the brain, to identify baseline characteristics, AC use, and outcomes.
RESULTS
A total of 65 patients were identified (mean age, 81.3 years); 35 (53.8%) had evidence of possible/probable CAA. Mean HAS-BLED score in the CAA group was significantly lower (2.1) than that of the non-CAA group (2.9; P<.001). Mortality after ICH, adjusted for HAS-BLED scores, was not significantly different among patients with and without CAA. Sixteen patients restarted on AC therapy after ICH; CHADS-VASc scores were no different between this group and those who were not restarted. Among patients with CAA, the overall rate of ICH recurrence was 8.6% over 93.5 person-years of follow-up. Among patients with CAA, the rate of ICH recurrence was 3.2 per 100 patient-years, higher than their HAS-BLED scores would predict (1.9 bleeds/100 patient-years).
CONCLUSION
HAS-BLED scores were lower in patients who had evidence of CAA compared with those without, suggesting underestimation of ICH risk in patients with CAA. CHADS-VASc scores did not affect resumption of AC therapy. ICH recurrence was higher in patients with CAA than their HAS-BLED scores predicted. Current risk assessment scoring systems do not accurately account for CAA in patients with AF on AC.
目的
确定 HAS-BLED（高血压、肾功能/肝功能异常、卒中、出血史或倾向、国际标准化比值不稳定、老年人、同时使用药物/酒精）和 CHADS-VASc（充血性心力衰竭、高血压、年龄、糖尿病、既往卒中/短暂性脑缺血发作-血管疾病）评分在伴有脑淀粉样血管病（CAA）的接受抗凝（AC）治疗的心房颤动（AF）患者中的作用。
患者和方法
使用罗切斯特流行病学项目数据库，从 1995 年至 2016 年期间接受 AC 治疗时发生非创伤性颅内出血（ICH）的 55 岁以上诊断为 AF 的患者中确定了研究对象。回顾了病历，包括脑成像，以确定基线特征、AC 使用和结局。
结果
共确定了 65 例患者（平均年龄 81.3 岁）；35 例（53.8%）有 CAA 的可能/确诊证据。CAA 组的 HAS-BLED 评分明显低于非 CAA 组（2.1 比 2.9；P<.001）。ICH 后，根据 HAS-BLED 评分调整后的死亡率在 CAA 患者与非 CAA 患者之间无显著差异。ICH 后，16 例患者重启 AC 治疗；该组与未重启的患者的 CHADS-VASc 评分无差异。在有 CAA 的患者中，总体 ICH 复发率在 93.5 人年的随访期间为 8.6%。在有 CAA 的患者中，ICH 复发率为每 100 患者年 3.2 例，高于其 HAS-BLED 评分预测的发生率（1.9 例/100 患者年）。
结论
与无 CAA 的患者相比，有 CAA 证据的患者 HAS-BLED 评分较低，提示 CAA 患者的 ICH 风险被低估。CHADS-VASc 评分不影响 AC 治疗的重启。在有 CAA 的患者中，ICH 复发率高于其 HAS-BLED 评分预测的发生率。目前的风险评估评分系统不能准确地考虑到接受 AC 治疗的 AF 患者中的 CAA。
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