Department of Cardiology, University Hospital of Split, Split 21000, Croatia.
Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele, Stoke-on-Trent ST5 5BG, UK.
Eur Heart J Qual Care Clin Outcomes. 2023 Dec 22;9(8):749-757. doi: 10.1093/ehjqcco/qcac090.
Atrial fibrillation (AF) is commonly encountered in cancer patients. We investigated the CHA2DS2VASc score, and its association with in-hospital ischaemic stroke in patients with cancer who were hospitalized for AF.
Using the United States National Inpatient Sample, all hospitalizations with principal diagnosis of AF between October 2015 and December 2018 were stratified by cancer diagnosis, type, and CHA2DS2VASc risk categories (low risk, low-moderate risk, moderate-high risk). In-hospital ischaemic stroke and its association with the CHA2DS2VASc risk score was assessed across the groups using hierarchical multivariable logistic regression with adjusted odds ratios (aOR) and 95% confidence intervals (95% CI). Discrimination of CHA2DS2VASc score for in-hospital ischaemic stroke was evaluated with Receiver Operating Characteristic and Area Under the Curve (AUC). Among 1 341 870 included hospitalizations, 71 965 (5.4%) had comorbid cancer. Cancer patients had a higher proportion of moderate-high CHA2DS2VASc risk compared with their non-cancer counterparts (86.5% vs. 82.3%, P < 0.001). Compared with their low CHA2DS2VASc risk counterparts, cancer patients in low-moderate and moderate-high risk scores had similar odds of developing stroke (aOR 1.28 95% CI 0.22-7.63 and aOR 1.78 95% CI 0.41-7.66, respectively). The CHA2DS2VASc risk score had poor discrimination for ischaemic stroke in the cancer group (AUC 0.538 95% CI 0.477-0.598).
Cancer patients with AF have high CHA2DS2VASc risk. Discrimination of CHA2DS2VASc for ischaemic stroke is lower in cancer than non-cancer patients, and CHA2DS2VASc may not be adequate in determining ischaemic risk in cancer population.
心房颤动（AF）在癌症患者中很常见。我们研究了 CHA2DS2VASc 评分及其与因 AF 住院的癌症患者院内缺血性卒中的关系。
使用美国国家住院患者样本，根据癌症诊断、类型和 CHA2DS2VASc 风险类别（低危、低-中危、中高危），对 2015 年 10 月至 2018 年 12 月期间主要诊断为 AF 的所有住院患者进行分层。使用分层多变量逻辑回归分析，评估不同组别中院内缺血性卒中及其与 CHA2DS2VASc 风险评分的关系，并计算调整后的优势比（aOR）和 95%置信区间（95%CI）。使用接受者操作特征和曲线下面积（AUC）评估 CHA2DS2VASc 评分对院内缺血性卒中的预测能力。在纳入的 1341870 例住院患者中，71965 例（5.4%）患有合并癌症。与非癌症患者相比，癌症患者具有更高比例的中高危 CHA2DS2VASc 风险（86.5% vs. 82.3%，P<0.001）。与低 CHA2DS2VASc 风险的癌症患者相比，低-中危和中高危评分的癌症患者发生卒中的可能性相似（aOR 1.28，95%CI 0.22-7.63 和 aOR 1.78，95%CI 0.41-7.66）。CHA2DS2VASc 风险评分对癌症患者的缺血性卒中预测能力较差（AUC 0.538，95%CI 0.477-0.598）。
患有 AF 的癌症患者具有较高的 CHA2DS2VASc 风险。CHA2DS2VASc 对癌症患者缺血性卒中的预测能力低于非癌症患者，且 CHA2DS2VASc 可能无法充分确定癌症人群的缺血风险。
