Cardiovascular Medicine (Cardiovascular Imaging Section), Cleveland Clinic, Cleveland, Ohio, USA.
Cardiovascular Medicine (Cardiac Electrophysiology and Pacing Section), Cleveland Clinic, Cleveland, Ohio, USA.
Open Heart. 2021 Nov;8(2). doi: 10.1136/openhrt-2021-001794.
The CHADS-VASc score is the preferred risk model for anticoagulation decision-making in atrial fibrillation (AF) patients. Recent studies have found this score to have prognostic value in other cardiovascular diseases. We assessed the relationships between CHADS-VASc score and long-term mortality in adults referred for stress testing, METHODS: 165 184 consecutive patients from January 1991 to December 2014 from a prospective registry were studied, with CHADS-VASc score calculated for all patients, and AF and anticoagulation status were recorded. The primary endpoint was all-cause mortality.
In this cohort, 12 450 (7.5%) patients had AF and mean CHADS-VASc score was 2.2±1.2. There were 22 152 (18.4%) deaths during mean follow-up of 6.1±4.8 years. In multivariable analysis, CHADS-VASc score, presence of AF and anticoagulation use, along with end-stage renal failure and smoking were all independently associated with mortality with HRs (95% CIs) of 1.23 (1.21 to 1.25), 1.18 (1.10 to 1.27) and 1.50 (1.40 to 1.60), respectively. Higher CHADS-VASc score was incrementally associated with worse survival both in patients with and without AF (log-rank p<0.001). Anticoagulation use was associated with reduced survival in non-AF patients with alternative anticoagulation indications at all CHADS-VASc score categories, and AF patients with lower CHADS-VASc score 0-2, but was protective in AF patients with higher CHADS-VASc score 4-9.
Incrementally higher CHA2DS2-VASc score, a simple clinical tool, is associated with mortality in patients regardless of presence of AF and anticoagulation status. Anticoagulation use was associated with worse survival in non-AF patients and AF patients with low CHADS-VASc scores, but was protective in AF patients with high CHADS-VASc scores.
CHADS-VASc 评分是心房颤动（AF）患者抗凝决策的首选风险模型。最近的研究发现，该评分在其他心血管疾病中有预后价值。我们评估了 CHADS-VASc 评分与因压力测试而转诊的成年人的长期死亡率之间的关系。
研究了 1991 年 1 月至 2014 年 12 月期间来自前瞻性登记处的 165184 例连续患者，为所有患者计算了 CHADS-VASc 评分，并记录了 AF 和抗凝状态。主要终点是全因死亡率。
在该队列中，12450 例（7.5%）患者患有 AF，平均 CHADS-VASc 评分为 2.2±1.2。在平均 6.1±4.8 年的随访期间，有 22152 例（18.4%）死亡。多变量分析显示，CHADS-VASc 评分、AF 及抗凝的存在、终末期肾病和吸烟与死亡率独立相关，HR（95%CI）分别为 1.23（1.21 至 1.25）、1.18（1.10 至 1.27）和 1.50（1.40 至 1.60）。在有和没有 AF 的患者中，较高的 CHADS-VASc 评分均与生存状况较差相关（对数秩检验，p<0.001）。在所有 CHADS-VASc 评分类别中，具有替代抗凝适应证的非 AF 患者，以及 CHADS-VASc 评分较低的 AF 患者（0-2），抗凝治疗与生存状况较差相关，但在 CHADS-VASc 评分较高的 AF 患者（4-9）中，抗凝治疗具有保护作用。
递增性更高的 CHA2DS2-VASc 评分，一种简单的临床工具，与有无 AF 和抗凝状态的患者的死亡率相关。在非 AF 患者和 CHADS-VASc 评分较低的 AF 患者中，抗凝治疗与生存状况较差相关，但在 CHADS-VASc 评分较高的 AF 患者中，抗凝治疗具有保护作用。
