Carol Davila University of Medicine and Pharmacy, Department of Internal Medicine, Bucharest, Romania; and.
Cardiology Department, Colentina University Hospital, Bucharest, Romania.
Am J Ther. 2021 Apr 7;28(3):e319-e334. doi: 10.1097/MJT.0000000000001357.
Atrial fibrillation (AF) is the most frequent sustained arrhythmia. It increases the risk of stroke, heart failure, death, hospitalizations, and costs.
Several scores were introduced to stratify the stroke risk and need for anticoagulation in patients (pts) with AF . CHA2DS2-VASc, the most frequently used score, as well as other stroke risk scores have been additionally applied to estimate outcomes for different other conditions, with inhomogeneous results. To date, there has been no consensus regarding the usefulness of these scores to estimate outcomes outside of thromboembolic risk assessment, and their value in estimating different end-point outcomes is still a subject of debate. We conducted this review to investigate whether the stroke risk scores' utility can be extended for the prediction of other severe outcomes in pts with AF.
We searched PubMed database and included studies that stratified the outcome of pts with AF by different stroke risk scores. We also included studies with a separate analysis of the pts with AF subpopulation.
Mortality rates increased with higher CHADS2 [from 2.28% (2.00%-2.58%) to 13.2% (8.24%-20.8%) per year] and CHA2DS2-VASc scores [risk ratio 1.26 (1.21-1.32), P < 0.0001 for score ≥3]. CHADS2 and CHA2DS2-VASc predicted poor outcome in stroke [odds ratio (OR) ranging 1.42-6 for CHADS2 and 1.3-7.3 for CHA2DS2-VASc]. Acute myocardial infarction rates increased with higher CHADS2 [OR 2.120 (1.942-2.315) P < 0.001] and CHA2DS2-VASc [OR 1.63 (1.53-1.75), P < 0.001]. Limited data were reported for ABC( Age, Biomarkers, Clinical histoty) and R2CHADS2. No statistically significant correlation was found for major bleeding.
CHADS2 and CHA2DS2-VASc are useful tools in identifying pts with AF at higher risk for all-cause death, regardless of other pathologies. Both scores correlated with the development of acute myocardial infarction, cardiovascular hospitalization, outcome in stroke, major adverse cardiovascular events, and major adverse cardiovascular and cerebral events, but not with serious bleeding.
心房颤动（AF）是最常见的持续性心律失常。它会增加中风、心力衰竭、死亡、住院和医疗费用的风险。
有几种评分系统被引入用于分层 AF 患者的中风风险和抗凝治疗需求。CHA2DS2-VASc 是最常用的评分系统，以及其他中风风险评分系统也被用于评估不同情况下的预后，但结果并不一致。迄今为止，关于这些评分系统是否可以用于血栓栓塞风险评估以外的预后评估尚无共识，它们在评估不同终点预后方面的价值仍存在争议。我们进行了这项综述，以调查中风风险评分的效用是否可以扩展到预测 AF 患者的其他严重结局。
我们搜索了 PubMed 数据库，并纳入了根据不同中风风险评分分层 AF 患者结局的研究。我们还纳入了单独分析 AF 亚组患者的研究。
死亡率随 CHADS2 评分升高而增加[从每年 2.28%（2.00%-2.58%）至 13.2%（8.24%-20.8%）]和 CHA2DS2-VASc 评分升高[风险比 1.26（1.21-1.32），P < 0.0001，评分≥3 分]。CHADS2 和 CHA2DS2-VASc 预测中风不良结局[比值比（OR）范围为 1.42-6 分用于 CHADS2 和 1.3-7.3 分用于 CHA2DS2-VASc]。急性心肌梗死发生率随 CHADS2 评分升高而增加[OR 2.120（1.942-2.315），P < 0.001]和 CHA2DS2-VASc 评分升高[OR 1.63（1.53-1.75），P < 0.001]。对于 ABC（年龄、生物标志物、临床病史）和 R2CHADS2，仅报道了有限的数据。主要出血无统计学显著相关性。
CHADS2 和 CHA2DS2-VASc 是识别 AF 患者全因死亡风险较高的有用工具，无论其他病理情况如何。这两个评分系统与急性心肌梗死、心血管住院、中风结局、主要不良心血管事件和主要不良心血管和脑事件的发生相关，但与严重出血无关。
