Department of Cardiology, Hirosaki University Graduate School of Medicine.
Division of Cardiology, Saiseikai Kumamoto Hospital.
Circ J. 2021 Jul 21;85(8):1254-1262. doi: 10.1253/circj.CJ-20-1075. Epub 2021 Mar 25.
Recently, identification of independent risk factors for ischemic stroke in Japanese non-valvular atrial fibrillation (NVAF) patients was made by analyzing the 5 major Japanese registries: J-RHYTHM Registry, Fushimi AF Registry, Shinken Database, Keio interhospital Cardiovascular Studies, and the Hokuriku-Plus AF Registry.
The predictive value of the risk scheme in Japanese NVAF patients was assessed. Of 16,918 patients, 12,289 NVAF patients were analyzed (mean follow up, 649±181 days). Hazard ratios (HRs) of each significant, independent risk factor were determined by using adjusted Cox-hazard proportional analysis. Scoring system for ischemic stroke was created by transforming HR logarithmically and was estimated by c-statistic. During the 21,820 person-years follow up, 241 ischemic stroke events occurred. Significant risk factors were: being elderly (aged 75-84 years [E], HR=1.74), extreme elderly (≥85 years [EE], HR=2.41), having hypertension (H, HR=1.60), previous stroke (S, HR=2.75), type of AF (persistent/permanent) (T, HR=1.59), and low body mass index <18.5 kg/m(L, HR=1.55) after adjusting for oral anticoagulant treatment. The score was assigned as follows: 1 point to H, E, L, and T, and 2 points to EE and S (HELT-ESscore). The C-statistic, using this score, was 0.681 (95% confidence interval [CI]=0.647-0.714), which was significantly higher than those using CHADS(0.647; 95% CI=0.614-0.681, P=0.027 for comparison) and CHADS-VASc scores (0.641; 95% CI=0.608-0.673, P=0.008).
The HELT-ESscore may be useful for identifying Japanese NVAF patients at risk of ischemic stroke.
最近，通过分析 5 个主要的日本注册研究：J-RHYTHM 注册研究、Fushimi AF 注册研究、Shinken 数据库、Keio 医院间心血管研究和 Hokuriku-Plus AF 注册研究，确定了日本非瓣膜性心房颤动（NVAF）患者发生缺血性卒中的独立危险因素。
评估了该风险方案在日本 NVAF 患者中的预测价值。在 16918 例患者中，分析了 12289 例 NVAF 患者（平均随访时间为 649±181 天）。使用调整后的 Cox 风险比例分析确定每个显著独立危险因素的风险比（HR）。通过对数变换 HR 构建缺血性卒中评分系统，并通过 c 统计量进行评估。在 21820 人年的随访期间，发生了 241 例缺血性卒中事件。显著的危险因素为：年龄较大（75-84 岁[E]，HR=1.74）、非常高龄（≥85 岁[EE]，HR=2.41）、高血压（H，HR=1.60）、既往卒中（S，HR=2.75）、房颤类型（持续性/永久性[T，HR=1.59]）和低体重指数<18.5kg/m（L，HR=1.55），调整抗凝治疗后。评分如下：H、E、L 和 T 各 1 分，EE 和 S 各 2 分（HELT-ES 评分）。使用该评分的 C 统计量为 0.681（95%置信区间[CI]：0.647-0.714），显著高于 CHADS（0.647；95%CI：0.614-0.681，P=0.027）和 CHADS-VASc 评分（0.641；95%CI：0.608-0.673，P=0.008）。
HELT-ES 评分可能有助于识别日本 NVAF 患者发生缺血性卒中的风险。
