Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
Department of Medicine, Ziauddin Medical University, Karachi, Pakistan.
Eur J Prev Cardiol. 2022 Mar 30;29(4):625-631. doi: 10.1093/eurjpc/zwab018.
Anticoagulants are the mainstay treatment for stroke prevention in patients with non-valvular atrial fibrillation (NVAF), and the CHA2DS2-VASc score is widely used to guide anticoagulation therapy in this cohort. However, utility of CHA2DS2-VASc in NVAF patients is debated, primarily because it is a vascular scoring system, which does not incorporate atrial fibrillation related parameters. Therefore, we conducted a meta-analysis to estimate the discrimination ability of CHA2DS2-VASc in predicting ischaemic stroke overall, and in subgroups of patients with or without NVAF.
PubMed and Embase databases were searched till June 2020 for published articles that assessed the discrimination ability of CHA2DS2-VASc, as measured by C-statistics, during mid-term (2-5 years) and long-term (>5 years) follow-up. Summary estimates were reported as random effects C-statistics with 95% confidence intervals (CIs). Seventeen articles were included in the analysis. Nine studies (n = 453 747 patients) reported the discrimination ability of CHA2DS2-VASc in NVAF patients, and 10 studies (n = 138 262 patients) in patients without NVAF. During mid-term follow-up, CHA2DS2-VASc predicted stroke with modest discrimination in the overall cohort [0.67 (0.65-0.69)], with similar discrimination ability in patients with NVAF [0.65 (0.63-0.68)] and in those without NVAF [0.69 (0.68-0.71)] (P-interaction = 0.08). Similarly, at long-term follow-up, CHA2DS2-VASc had modest discrimination [0.66 (0.63-0.69)], which was consistent among patients with NVAF [0.63 (0.54-0.71)] and those without NVAF [0.67 (0.64-0.70)] (P-interaction = 0.39).
This meta-analysis suggests that the discrimination power of the CHA2DS2-VASc score in predicting ischaemic stroke is modest, and is similar in the presence or absence of NVAF. More accurate stroke prediction models are thus needed for the NVAF population.
抗凝剂是预防非瓣膜性心房颤动（NVAF）患者中风的主要治疗方法，CHA2DS2-VASc 评分广泛用于指导该人群的抗凝治疗。然而，CHA2DS2-VASc 在 NVAF 患者中的应用存在争议，主要是因为它是一种血管评分系统，并未包含房颤相关参数。因此，我们进行了一项荟萃分析，以评估 CHA2DS2-VASc 在预测总体缺血性中风以及 NVAF 患者和非 NVAF 患者亚组中的区分能力。
检索了 PubMed 和 Embase 数据库，以获取评估 CHA2DS2-VASc 区分能力的已发表文章，通过 C 统计量进行中期（2-5 年）和长期（>5 年）随访进行评估。汇总估计值作为随机效应 C 统计量，报告为 95%置信区间（CIs）。共纳入 17 项研究。9 项研究（n=453747 例患者）报告了 CHA2DS2-VASc 在 NVAF 患者中的区分能力，10 项研究（n=138262 例患者）报告了非 NVAF 患者中的区分能力。在中期随访中，CHA2DS2-VASc 在总体队列中对中风的预测具有适度的区分能力[0.67（0.65-0.69）]，在 NVAF 患者[0.65（0.63-0.68）]和非 NVAF 患者[0.69（0.68-0.71）]中具有相似的区分能力（P 交互=0.08）。同样，在长期随访中，CHA2DS2-VASc 具有适度的区分能力[0.66（0.63-0.69）]，在 NVAF 患者[0.63（0.54-0.71）]和非 NVAF 患者[0.67（0.64-0.70）]中也具有相似的区分能力（P 交互=0.39）。
这项荟萃分析表明，CHA2DS2-VASc 评分预测缺血性中风的区分能力适中，在存在或不存在 NVAF 的情况下相似。因此，需要针对 NVAF 人群建立更准确的中风预测模型。
