Wu Yaxin, Gao Yanxiang, Li Qing, Wu Chao, Xie Enmin, Tu Yimin, Guo Ziyu, Ye Zixiang, Li Peizhao, Li Yike, Yu Xiaozhai, Ren Jingyi, Zheng Jingang
Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China.
Department of Cardiology, China-Japan Friendship Hospital, Beijing, China.
Front Cardiovasc Med. 2022 Mar 16;9:790193. doi: 10.3389/fcvm.2022.790193. eCollection 2022.
Chronic kidney disease (CKD) patients have a high prevalence of coronary artery disease and a high risk of cardiovascular events. The present study assessed the value of the CHADS-VASc score for predicting mortality among hospitalized acute coronary syndrome (ACS) patients with CKD.
This was a retrospective cohort study that included CKD patients who were hospitalized for ACS from January 2015 to May 2020. The CHADS-VASc score for each eligible patient was determined. Patients were stratified into two groups according to CHADS-VASc score: <6 (low) and ≥6 (high). The primary endpoint was all-cause mortality.
A total of 313 eligible patients were included in the study, with a mean CHADS-VASC score of 4.55 ± 1.68. A total of 220 and 93 patients were assigned to the low and high CHADS-VASc score groups, respectively. The most common reason for hospitalization was unstable angina (39.3%), followed by non-ST-elevation myocardial infarction (35.8%) and ST-elevation myocardial infarction (24.9%). A total of 67.7% of the patients (212/313) received coronary reperfusion therapy during hospitalization. The median follow-up time was 23.0 months (interquartile range: 12-38 months). A total of 94 patients (30.0%) died during follow-up. The high score group had a higher mortality rate than the low score group (46.2 vs. 23.2%, respectively; < 0.001). The cumulative incidence of all-cause death was higher in the high score group than in the low score group (Log-rank test, < 0.001). Multivariate Cox regression analysis indicated that CHADS-VASc scores were positively associated with all-cause mortality (hazard ratio: 2.02, 95% confidence interval: 1.26-3.27, < 0.001).
The CHADS-VASc score is an independent predictive factor for all-cause mortality in CKD patients who are hospitalized with ACS. This simple and practical scoring system may be useful for the early identification of patients with a high risk of death.
慢性肾脏病（CKD）患者冠状动脉疾病患病率高，心血管事件风险高。本研究评估了CHADS-VASc评分对预测住院急性冠状动脉综合征（ACS）合并CKD患者死亡率的价值。
这是一项回顾性队列研究，纳入了2015年1月至2020年5月因ACS住院的CKD患者。确定了每位符合条件患者的CHADS-VASc评分。根据CHADS-VASc评分将患者分为两组：<6（低）和≥6（高）。主要终点是全因死亡率。
本研究共纳入313例符合条件的患者，CHADS-VASC评分均值为4.55±1.68。分别有220例和93例患者被分配到CHADS-VASc评分低分组和高分组。住院最常见原因是不稳定型心绞痛（39.3%），其次是非ST段抬高型心肌梗死（35.8%）和ST段抬高型心肌梗死（24.9%）。共有67.7%的患者（212/313）在住院期间接受了冠状动脉再灌注治疗。中位随访时间为23.0个月（四分位间距：12 - 38个月）。共有94例患者（30.0%）在随访期间死亡。高评分组的死亡率高于低评分组（分别为46.2%和23.2%；<0.001）。高评分组全因死亡的累积发生率高于低评分组（对数秩检验，<0.001）。多因素Cox回归分析表明，CHADS-VASc评分与全因死亡率呈正相关（风险比：2.02，95%置信区间：1.26 - 3.27，<0.001）。
CHADS-VASc评分是住院ACS合并CKD患者全因死亡率的独立预测因素。这个简单实用的评分系统可能有助于早期识别死亡风险高的患者。
