应用 CHADS-VASc 评分预测房颤患者的后续心肌梗死。

Use of the CHADS-VASc score to predict subsequent myocardial infarction in atrial fibrillation.

机构信息

School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan, ROC; Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, ROC.

Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Taiwan, ROC.

出版信息

Hellenic J Cardiol. 2024 Jul-Aug;78:42-49. doi: 10.1016/j.hjc.2023.08.010. Epub 2023 Aug 25.

DOI:10.1016/j.hjc.2023.08.010

PMID:37633490

Abstract

BACKGROUND

The risk of subsequent myocardial infarction (MI) varies widely in patients with atrial fibrillation (AF). No convenient scoring system currently exists to identify MI in AF. While each element of the CHA2DS2-VASc (congestive heart failure; hypertension; age ≥75 years [doubled]; type 2 diabetes; previous stroke or thromboembolism [doubled]; vascular disease; age 65-75 years; and sex category) score can increase the likelihood of MI, this retrospective longitudinal study aimed to determine the accuracy of the CHA2DS2-VASc score in predicting subsequent MI risk in AF.

METHODS

A total of 29,341 patients with AF were enrolled and followed up from January 2010 until the first occurrence of MI or until December 2020. The primary endpoint was the occurrence of subsequent MI.

RESULTS

The average age of the study population was 71 years, and 43.2% were male. The mean CHA2DS2-VASc score was found to be higher in patients with AF who had experienced an MI than in those who had not (3.56 ± 1.92 vs. 3.32 ± 1.81, p < 0.001). During the long-term follow-up, the risk of subsequent MI increased by 22% with every one-point increase in the CHA2DS2-VASc score (hazard ratio 1.22, 95% confidence interval 1.19-1.25; p < 0.001). Kaplan-Meier analysis revealed that high CHA2DS2-VASc scores were more likely to experience an MI than those with low CHA2DS2-VASc scores (log-rank p < 0.001). Furthermore, the CHA2DS2-VASc score was a significant predictor of MI in multivariate regression analysis.

CONCLUSION

The CHADS-VASc score is a valuable predictor of subsequent MI risk in patients with AF.

摘要

背景

心房颤动（AF）患者发生后续心肌梗死（MI）的风险差异很大。目前尚无方便的评分系统来识别 AF 中的 MI。尽管 CHA2DS2-VASc（充血性心力衰竭；高血压；年龄≥75 岁[加倍]；2 型糖尿病；既往中风或血栓栓塞[加倍]；血管疾病；65-75 岁；和性别类别）评分的每个元素都可以增加 MI 的可能性，但这项回顾性纵向研究旨在确定 CHA2DS2-VASc 评分在预测 AF 患者后续 MI 风险中的准确性。

方法

共纳入 29341 例 AF 患者，从 2010 年 1 月至首次发生 MI 或 2020 年 12 月进行随访。主要终点是发生后续 MI。

结果

研究人群的平均年龄为 71 岁，43.2%为男性。与未发生 MI 的患者相比，发生 MI 的 AF 患者的 CHA2DS2-VASc 评分更高（3.56±1.92 比 3.32±1.81，p<0.001）。在长期随访中，CHA2DS2-VASc 评分每增加 1 分，发生后续 MI 的风险增加 22%（危险比 1.22，95%置信区间 1.19-1.25；p<0.001）。Kaplan-Meier 分析显示，高 CHA2DS2-VASc 评分患者发生 MI 的可能性高于低 CHA2DS2-VASc 评分患者（对数秩检验 p<0.001）。此外，CHA2DS2-VASc 评分是多变量回归分析中 MI 的显著预测因子。