Bungo Brandon, Chaudhury Pulkit, Arustamyan Michael, Rikhi Rishi, Hussain Muzna, Collier Patrick, Kanj Mohamed, Khorana Alok A, Mentias Amgad, Moudgil Rohit
Section of Clinical Cardiology, United States.
Taussig Cancer Institute and Case Comprehensive Cancer Center, Cleveland Clinic Foundation, United States.
Int J Cardiol Heart Vasc. 2022 Jun 20;41:101072. doi: 10.1016/j.ijcha.2022.101072. eCollection 2022 Aug.
Atrial fibrillation (AF) is associated with an increased risk of stroke. Despite evidence linking cancer and thrombosis, cancer is not part of the CHADSVASc score.
Cancer is an independent risk factor for thromboembolic stroke in patients with AF.
The SEER database was utilized to identify patients with lung, colon, breast, and prostate cancers with AF and no prior diagnosis of stroke and. compared to controls within the dataset. The primary endpoint was rates of stroke per 100 person-years. Cox regression modeling and a nested model comparing CHADSVASc score (Model 1) with a complete model including cancer diagnosis (Model 2) were performed. Models were compared using Akaike Information Criterion (AIC) and Net Reclassification Index (NRI). A propensity-matched cohort with equivalent CHADSVASc scores determining stroke-free survival was also performed.
A total of 101,185 patients were included in the analysis, with 48,242 in the Cancer and 52,943 in the Non-cancer Group. Stroke rate per 100 person-years was significantly higher in the Cancer Group. The CHADSVASc model (Model 1) was compared against a model including cancer (Model 2) showing improved predictability as assessed by both NRI and AIC. Cox regression analysis calculated a hazard ratio of 1.085 for Cancer, which was comparable to age >75, female sex, and diabetes. Propensity matched Kaplan-Meier curve demonstrated a decreased probability of stroke-free survival in the Cancer Group.
Cancers increase the risk of stroke in patients with AF. Consideration should be given to the addition of cancer to the clinical scoring system.
心房颤动（AF）与中风风险增加相关。尽管有证据表明癌症与血栓形成有关，但癌症并非CHADSVASc评分的一部分。
癌症是AF患者发生血栓栓塞性中风的独立危险因素。
利用监测、流行病学与最终结果（SEER）数据库识别患有肺癌、结肠癌、乳腺癌和前列腺癌且伴有AF且既往无中风诊断的患者，并与数据集中的对照组进行比较。主要终点是每100人年的中风发生率。进行了Cox回归建模以及将CHADSVASc评分模型（模型1）与包含癌症诊断的完整模型（模型2）进行比较的嵌套模型分析。使用赤池信息准则（AIC）和净重新分类指数（NRI）对模型进行比较。还进行了具有等效CHADSVASc评分以确定无中风生存期的倾向匹配队列分析。
分析共纳入101,185例患者，癌症组48,242例，非癌症组52,943例。癌症组每100人年的中风发生率显著更高。将CHADSVASc模型（模型1）与包含癌症的模型（模型2）进行比较，结果显示，根据NRI和AIC评估，后者具有更好的预测性。Cox回归分析计算出癌症的风险比为1.085，这与年龄>75岁、女性和糖尿病相当。倾向匹配的Kaplan-Meier曲线显示癌症组无中风生存期的概率降低。
癌症会增加AF患者中风的风险。应考虑将癌症纳入临床评分系统。
