泰国非瓣膜性心房颤动患者 RCHADS-VA 评分预测血栓栓塞的有效性。
Efficacy of RCHADS-VA score for predicting thromboembolism in Thai patients with non-valvular atrial fibrillation.
机构信息
Department of Cardiology, Central Chest Institute of Thailand, Nonthaburi, Thailand.
Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
出版信息
BMC Cardiovasc Disord. 2021 Nov 12;21(1):540. doi: 10.1186/s12872-021-02370-2.
BACKGROUND
There is no data specific to the addition of renal dysfunction and age 50-64 years as risk parameters to the CHADS-VA score, which is known as the RCHADS-VA score, among NVAF patients. Accordingly, the aim of this study was to validate the RCHADS-VA score for predicting thromboembolism in Thai NVAF patients.
METHODS
Thai NVAF patients were prospectively enrolled in a nationwide multicenter registry from 27 hospitals during 2014-2020. Each component of the CHADS-VA and RCHADS-VA scores was scored and recorded. The main outcomes were thromboembolism, including ischemic stroke, transient ischemic attack (TIA), and/or systemic embolism. The annual incidence rate of thromboembolism among patients in each RCHADS-VA and CHADS-VA risk score category is shown as hazard ratio (HR) and 95% confidence interval (95% CI). The performance of the RCHADS-VA and CHADS-VA scores was demonstrated using c-statistics. Net reclassification index was calculated. Calibration plat was used to assess agreement between observed probabilities and predicted probabilities of both scoring system.
RESULTS
A total of 3402 patients were enrolled during 2014-2020. The average age of patients was 67.38 ± 11.27 years. Of those, 46.9% had renal disease, 30.7% had a history of heart failure, and 17.1% had previous stroke or TIA. The average RCHADS-VA and CHADS-VA scores were 3.92 ± 1.92 and 2.98 ± 1.43, respectively. Annual thromboembolic risk increased with incremental increase in RCHADS-VA and CHADS-VA scores. Oral anticoagulants had benefit in stroke prevention in NVAF patients with an RCHADS-VA score of 2 or more (adjusted HR: 0.630, 95% CI 0.413-0.962, p = 0.032). The c-statistics were 0.630 (95% CI 0.61-0.65) and 0.627 (95% CI 0.61-0.64), for RCHADS-VA and CHA2DS2-VA scores respectively. NRI was 2.2%. The slope and R2 of the calibration plot were 0.73 and 0.905 for RCHADS-VA and 0.70 and 0.846 for CHADS-VA score respectively.
CONCLUSIONS
RCHADS-VA score was found to be at least as good as CHADS-VA score for predicting thromboembolism in Thai patients with NVAF. Similar to CHADS-VA score, thromboembolism increased with incremental increase in RCHADS-VA score.
背景
在 NVAF 患者中，没有专门针对肾功能障碍和年龄 50-64 岁这两个风险参数加入 CHADS-VA 评分的 RCHADS-VA 评分的数据。因此，本研究旨在验证 RCHADS-VA 评分在泰国 NVAF 患者中预测血栓栓塞的能力。
方法
泰国 NVAF 患者于 2014 年至 2020 年期间在 27 家医院进行了一项全国多中心前瞻性登记研究。每个 CHADS-VA 和 RCHADS-VA 评分的组成部分都进行了评分和记录。主要结局为血栓栓塞，包括缺血性卒中和/或系统性栓塞。在每个 RCHADS-VA 和 CHADS-VA 风险评分类别中，患者的血栓栓塞年发生率以危险比（HR）和 95%置信区间（95%CI）表示。使用 C 统计量来展示 RCHADS-VA 和 CHADS-VA 评分的性能。计算净重新分类指数。校准平台用于评估两个评分系统的观察概率与预测概率之间的一致性。
结果
共纳入 2014 年至 2020 年期间的 3402 例患者。患者平均年龄为 67.38±11.27 岁，其中 46.9%患有肾脏疾病，30.7%有心力衰竭史，17.1%有既往卒中和 TIA。平均 RCHADS-VA 和 CHADS-VA 评分为 3.92±1.92 和 2.98±1.43。随着 RCHADS-VA 和 CHADS-VA 评分的增加，每年的血栓栓塞风险也随之增加。在 RCHADS-VA 评分≥2 分的 NVAF 患者中，口服抗凝药物对预防卒中具有获益（校正 HR：0.630，95%CI：0.413-0.962，p=0.032）。RCHADS-VA 和 CHA2DS2-VA 评分的 C 统计量分别为 0.630（95%CI：0.61-0.65）和 0.627（95%CI：0.61-0.64）。NRI 为 2.2%。RCHADS-VA 和 CHADS-VA 评分的校准图斜率和 R2 分别为 0.73 和 0.905，0.70 和 0.846。
结论
在泰国 NVAF 患者中，RCHADS-VA 评分预测血栓栓塞的能力至少与 CHADS-VA 评分相当。与 CHADS-VA 评分一样，血栓栓塞随着 RCHADS-VA 评分的增加而增加。
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