Ørskov Marie, Vorum Henrik, Larsen Torben Bjerregaard, Skjøth Flemming
Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
Department of Clinical Medicine, Aalborg Thrombosis Research Unit, Faculty of Health, Aalborg University, Aalborg, Denmark.
TH Open. 2022 Nov 30;6(4):e429-e436. doi: 10.1055/s-0042-1758713. eCollection 2022 Oct.
We investigated the 1-year risk of stroke in patients with retinal artery occlusion and evaluated the predictive and discriminating abilities of contemporary risk stratification models for embolic stroke. This register-based cohort study included 7,906 patients with retinal artery occlusion from Danish nationwide patient registries between 1995 and 2018. The study population was stratified according to the number of points obtained in the stroke risk scores: the CHA DS -VASc score and the ESSEN Stroke Risk score. The 1-year risk of stroke within strata was evaluated and compared using the cox proportional hazards model. Furthermore, the discrimination of the risk scores as predictive tools for stroke risk assessment was investigated using C-statistics, Brier score, and the index of prediction accuracy. The stroke event rate in patients with retinal artery occlusion increased as the score increased for both risk scores, ranging from 3.62 (95% confidence interval [CI]: 2.46-5.31) per 100 person-years to 13.25 (95% CI: 11.78--14.89) per 100-person-years for increasing levels of the CHA DS -VASc score and from 3.97 (95% CI: 2.97-5.32) per 100 person-years to 16.43 (95% CI: 14.01-19.27) per 100 person-years for increasing levels of the ESSEN Stroke Risk score. Using a risk score of 0 as a reference, the difference was statistically significant for retinal artery occlusion patients with a CHA DS -VASc score of 2 or above and for all levels of the ESSEN Stroke Risk score. The C-statistics for the risk scores was 61% (95% CI: 58%-63%) and 62% (95% CI: 59-64%) for the CHA DS -VASc score and ESSEN Stroke Risk score, respectively. The results suggested that the use of the CHA DS -VASc score and the ESSEN Stroke Risk score was applicable for risk stratification of stroke in patients with retinal artery occlusion, but discrimination was poor due to low specificity.
我们调查了视网膜动脉阻塞患者的1年中风风险，并评估了当代栓塞性中风风险分层模型的预测和鉴别能力。 这项基于登记处的队列研究纳入了1995年至2018年间丹麦全国患者登记处的7906例视网膜动脉阻塞患者。研究人群根据中风风险评分（CHA DS -VASc评分和ESSEN中风风险评分）获得的分数进行分层。使用Cox比例风险模型评估和比较各层内的1年中风风险。此外，使用C统计量、Brier评分和预测准确性指数，研究了风险评分作为中风风险评估预测工具的鉴别能力。 随着两种风险评分的增加，视网膜动脉阻塞患者的中风事件发生率也随之增加，CHA DS -VASc评分水平升高时，每100人年的发生率从3.62（95%置信区间[CI]：2.46-5.31）增至13.25（95%CI：11.78-14.89），ESSEN中风风险评分水平升高时，每100人年的发生率从3.97（95%CI：2.97-5.32）增至16.43（95%CI：14.01-19.27）。以0分的风险评分为参考，CHA DS -VASc评分为2分及以上的视网膜动脉阻塞患者以及所有水平的ESSEN中风风险评分的差异均具有统计学意义。CHA DS -VASc评分和ESSEN中风风险评分的C统计量分别为61%（95%CI：58%-63%）和62%（95%CI：59-64%）。 结果表明，CHA DS -VASc评分和ESSEN中风风险评分适用于视网膜动脉阻塞患者的中风风险分层，但由于特异性较低，鉴别能力较差。
