Ukaji Tomoaki, Ishikawa Tetsuya, Nakamura Hidehiko, Mizutani Yukiko, Yamada Kouta, Shimura Masatoshi, Kondo Yuki, Tamura Yohei, Koshikawa Yuri, Hisauchi Itaru, Nakahara Shiro, Itabashi Yuji, Kobayashi Sayuki, Taguchi Isao
Department of Cardiology, Dokkyo Medical University, Saitama Medical Center Koshigaya Japan.
Circ Rep. 2023 Mar 15;5(4):123-132. doi: 10.1253/circrep.CR-22-0120. eCollection 2023 Apr 10.
The prognostic impact of CHADS, CHADS-VASc, and CHADS-VASc-HS scores on clinical outcomes after drug-eluting stent (DES) placement has not been fully elucidated. The present study was a retrospective, non-randomized, single-center, and lesion-based study. Target lesion failure (TLF), comprising cardiac death, non-fatal myocardial infarction, and target vessel revascularization, occurred in 7.1% of 872 consecutive de novo coronary lesions in 586 patients. These patients were electively and exclusively treated by DESs from January 2016 to January 2022 until July 2022 with a mean (±SD) observational interval of 411±438 days. Multivariate Cox proportional hazard analysis revealed that CHADS-VASc-HS scores ≥7 (hazard ratio [HR] 1.800; 95% CI 1.06-3.05; P=0.029) was a significant predictor of cumulative TLF among 24 variables evaluated. CHADS scores ≥2 (HR 3.213; 95% CI 1.32-7.80; P=0.010) and CHADS-VASc scores ≥5 (HR 1.980; 95% CI 1.10-3.55; P=0.022) were also significant in the multivariate analysis. Pairwise comparisons of receiver operating characteristic curves for CHADS score ≥2, CHADS-VASc score ≥5, and CHADS-VASc-HS score ≥7 showed they were equivalent in terms of predicting the incidence of TLF, with areas under the curve of 0.568, 0.575, and 0.573, respectively. All 3 cardiocerebrovascular thromboembolism risk scores were strong predictors of the incidence of cumulative mid-term TLF after elective DES placement, with cut-off values of 2, 5, and 7, respectively, and equivalent prognostic impacts.
CHADS、CHADS-VASc和CHADS-VASc-HS评分对药物洗脱支架（DES）置入术后临床结局的预后影响尚未完全阐明。本研究是一项回顾性、非随机、单中心且基于病变的研究。在586例患者的872处连续新发冠状动脉病变中，目标病变失败（TLF，包括心源性死亡、非致命性心肌梗死和靶血管血运重建）发生率为7.1%。这些患者在2016年1月至2022年1月期间接受DES选择性且专门治疗，直至2022年7月，平均（±标准差）观察期为411±438天。多因素Cox比例风险分析显示，在评估的24个变量中，CHADS-VASc-HS评分≥7（风险比[HR]1.800；95%置信区间1.06 - 3.05；P = 0.029）是累积TLF的显著预测因素。CHADS评分≥2（HR 3.213；95%置信区间1.32 - 7.80；P = 0.010）和CHADS-VASc评分≥5（HR 1.980；95%置信区间1.10 - 3.55；P = 0.022）在多因素分析中也具有显著性。CHADS评分≥2、CHADS-VASc评分≥5和CHADS-VASc-HS评分≥7的受试者工作特征曲线的两两比较显示，它们在预测TLF发生率方面相当，曲线下面积分别为0.568、0.575和0.573。所有3种心脑血管血栓栓塞风险评分都是择期DES置入术后累积中期TLF发生率的强预测因素，截断值分别为2、5和7，且预后影响相当。
