Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
Thromb Haemost. 2021 Aug;121(8):1107-1114. doi: 10.1055/a-1333-4448. Epub 2021 Jan 26.
Evaluation of thromboembolic risk is essential in anticoagulated atrial fibrillation (AF) patients. The CHADS-VASc score is largely validated and recommended by most guidelines. The GARFIELD-AF Stroke score has been proposed as an alternative risk score.
We analyzed warfarin-treated patients from SPORTIF III and V studies. Any thromboembolic event (TE) was an study outcome. We compared the two scores' capacity in predicting any TE occurrence.
A total of 3,665 patients (median [interquartile range] age: 72 [66-77] years; 30.5% female) were included in this analysis. After a mean (standard deviation) follow-up of 566.3 (142.5) days, 148 (4.03%) TEs were recorded. Both continuous CHADS-VASc and GARFIELD-AF were associated with TE (hazard ratio [HR]: 1.37, 95% confidence interval [CI]: 1.22-1.53 and HR: 2.43, 95% CI: 1.72-3.42), with modest predictive ability (c-indexes: 0.63, 95% CI: 0.59-0.68 and 0.61, 95% CI: 0.56-0.66, respectively), with no differences. CHADS-VASc quartiles showed an increasing cumulative risk, while in GARFIELD-AF only the highest quartile (Q4) demonstrated an increased TE risk. On multivariate Cox regression analysis, CHADS-VASc quartiles were associated with increasing risk of TE, whereas for GARFIELD-AF only Q4 showed an association with TE. Discrimination analysis showed that GARFIELD-AF quartiles were associated with a 48.7% reduction in discriminatory ability. Using decision curve analysis, CHADS-VASc was associated with improved clinical usefulness and net clinical benefit, compared with GARFIELD-AF.
In a warfarin-treated trial cohort of AF patients, both CHADS-VASc and GARFIELD-AF Stroke scores were associated with adjudicated TE events, with modest predictive capacity. The simpler CHADS-VASc score improved discriminatory capacity compared with the more complex GARFIELD-AF score, demonstrating improved clinical usefulness and net clinical benefit.
评估血栓栓塞风险对于接受抗凝治疗的心房颤动（AF）患者至关重要。CHA2DS2-VASc 评分已得到广泛验证，并被大多数指南推荐。GARFIELD-AF 卒中评分已被提出作为替代风险评分。
我们分析了 SPORTIF III 和 V 研究中的华法林治疗患者。任何血栓栓塞事件（TE）均为研究结局。我们比较了两种评分预测任何 TE 发生的能力。
共纳入 3665 例患者（中位数[四分位间距]年龄：72[66-77]岁；30.5%为女性）。平均（标准差）随访 566.3（142.5）天后，记录到 148 例（4.03%）TE。连续 CHADS2-VASc 和 GARFIELD-AF 均与 TE 相关（风险比[HR]：1.37，95%置信区间[CI]：1.22-1.53 和 HR：2.43，95% CI：1.72-3.42），预测能力中等（C 指数：0.63，95% CI：0.59-0.68 和 0.61，95% CI：0.56-0.66），无差异。CHADS2-VASc 四分位数显示累积风险逐渐增加，而在 GARFIELD-AF 中，仅最高四分位数（Q4）显示 TE 风险增加。多变量 Cox 回归分析显示，CHADS2-VASc 四分位数与 TE 风险增加相关，而 GARFIELD-AF 仅 Q4 与 TE 相关。判别分析显示，GARFIELD-AF 四分位数与判别能力降低 48.7%相关。使用决策曲线分析，与 GARFIELD-AF 相比，CHADS2-VASc 与改善的临床实用性和净临床获益相关。
在接受华法林治疗的 AF 患者试验队列中，CHA2DS2-VASc 和 GARFIELD-AF 卒中评分均与裁定的 TE 事件相关，具有中等预测能力。与更复杂的 GARFIELD-AF 评分相比，更简单的 CHADS2-VASc 评分提高了判别能力，显示出改善的临床实用性和净临床获益。
