Deng J L, He L, Jiang C, Lai Y W, Long D Y, Sang C H, Jia C Q, Feng L, Li X, Ning M, Hu R, Dong J Z, Du X, Tang R B, Ma C S
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2022 Sep 24;50(9):888-894. doi: 10.3760/cma.j.cn112148-20210826-00740.
To compare the differences between CAS risk model and CHADS-VASc risk score in predicting all cause death, thromboembolic events, major bleeding events and composite endpoint in patients with nonvalvular atrial fibrillation. This is a retrospective cohort study. From the China Atrial Fibrillation Registry cohort study, the patients with atrial fibrillation who were>18 years old were randomly divided into CAS risk score group and CHADS-VASc risk score group respectively. According to the anticoagulant status at baseline and follow-up, patients in the 2 groups who complied with the scoring specifications for anticoagulation were selected for inclusion in this study. Baseline information such as age and gender in the two groups were collected and compared. Follow-up was performed periodically to collect information on anticoagulant therapy and endpoints. The endpoints were all-cause death, thromboembolism events and major bleeding, the composite endpoint events were all-cause death and thromboembolism events. The incidence of endpoints in CAS group and CHADS-VASc group was analyzed, and multivariate Cox proportional risk model was used to analyze whether the incidence of the endpoints was statistically different between the two groups. A total of 5 206 patients with AF were enrolled, average aged (63.6±12.2) years, and 2092 (40.2%) women. There were 2 447 cases (47.0%) in CAS risk score group and 2 759 cases (53.0%) in CHADS-VASc risk score group. In the clinical baseline data of the two groups, the proportion of left ventricular ejection fraction<55%, non-paroxysmal atrial fibrillation, oral warfarin and HAS BLED score in the CAS group were lower than those in the CHADS-VASc group, while the proportion of previous diabetes history and history of antiplatelet drugs in the CAS group was higher than that in the CHADS-VASc group, and there was no statistical difference in other baseline data. Patients were followed up for (82.8±40.8) months. In CAS risk score group, 225(9.2%) had all-cause death, 186 (7.6%) had thromboembolic events, 81(3.3%) had major bleeding, and 368 (15.0%) had composite endpoint. In CHADS-VASc risk score group, 261(9.5%) had all-cause death 209(7.6%) had thromboembolic events, 112(4.1%) had major bleeding, and 424 (15.4%) had composite endpoint. There were no significant differences in the occurrence of all-cause death, thromboembolic events, major bleeding and composite endpoint between anticoagulation in CAS risk score group and anticoagulation in CHADS-VASc risk score group (log-rank =0.643, 0.904, 0.126, 0.599, respectively). Compared with CAS risk score, multivariable Cox proportional hazards regression models showed no significant differences for all-cause death, thromboembolic events, major bleeding and composite endpoint between the two groups with (95%) 0.95(0.80-1.14), 1.00(0.82-1.22), 0.83(0.62-1.10), 0.96(0.84-1.11), respectively. All >0.05. There were no significant differences between CAS risk model and CHADS-VASc risk score in predicting all-cause death, thromboembolic events, and major bleeding events in Chinese patients with non-valvular atrial fibrillation.
比较CAS风险模型与CHADS-VASc风险评分在预测非瓣膜性心房颤动患者全因死亡、血栓栓塞事件、大出血事件及复合终点方面的差异。这是一项回顾性队列研究。从中国心房颤动注册队列研究中，将年龄>18岁的心房颤动患者随机分为CAS风险评分组和CHADS-VASc风险评分组。根据基线和随访时的抗凝状态，选取两组中符合抗凝评分规范的患者纳入本研究。收集并比较两组患者的年龄、性别等基线信息。定期进行随访，收集抗凝治疗及终点事件信息。终点事件为全因死亡、血栓栓塞事件和大出血，复合终点事件为全因死亡和血栓栓塞事件。分析CAS组和CHADS-VASc组终点事件的发生率，并采用多因素Cox比例风险模型分析两组终点事件发生率是否存在统计学差异。共纳入5206例房颤患者，平均年龄（63.6±12.2）岁，女性2092例（40.2%）。CAS风险评分组2447例（47.0%），CHADS-VASc风险评分组2759例（53.0%）。两组临床基线资料中，CAS组左心室射血分数<55%、非阵发性心房颤动、口服华法林及HAS BLED评分的比例低于CHADS-VASc组，而CAS组既往糖尿病史及抗血小板药物史的比例高于CHADS-VASc组，其他基线资料无统计学差异。患者随访时间为（82.8±40.8）个月。CAS风险评分组中，全因死亡225例（9.2%），血栓栓塞事件186例（7.6%），大出血81例（3.3%），复合终点368例（15.0%）。CHADS-VASc风险评分组中，全因死亡261例（9.5%），血栓栓塞事件209例（7.6%），大出血112例（4.1%），复合终点424例（15.4%）。CAS风险评分组抗凝与CHADS-VASc风险评分组抗凝在全因死亡、血栓栓塞事件、大出血及复合终点的发生情况上无显著差异（对数秩检验分别为=0.643、0.904、0.126、0.599）。与CAS风险评分相比，多因素Cox比例风险回归模型显示两组在全因死亡、血栓栓塞事件、大出血及复合终点方面无显著差异，（95%）置信区间分别为0.95（0.80 - 1.14）、1.00（0.82 - 1.22）、0.83（0.62 - 1.10）、0.96（0.84 - 1.11），均>0.05。CAS风险模型与CHADS-VASc风险评分在预测中国非瓣膜性心房颤动患者全因死亡、血栓栓塞事件及大出血事件方面无显著差异。
