亚太心律学会心房颤动注册研究中COOL-AF评分的外部验证
External Validation of COOL-AF Scores in the Asian Pacific Heart Rhythm Society Atrial Fibrillation Registry.
作者信息
Bucci Tommaso, Shantsila Alena, Romiti Giulio Francesco, Teo Wee-Siong, Chao Tze-Fan, Shimizu Wataru, Boriani Giuseppe, Tse Hung-Fat, Krittayaphong Rungroj, Lip Gregory Y H
机构信息
Liverpool Centre of Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.
Department of General and Specialized Surgery, Sapienza University of Rome, Rome, Italy.
出版信息
JACC Asia. 2023 Nov 14;4(1):59-69. doi: 10.1016/j.jacasi.2023.09.011. eCollection 2024 Jan.
BACKGROUND
The COOL-AF (Cohort of Antithrombotic Use and Optimal International Normalized Ratio Levels in Patients with Atrial Fibrillation) risk scores for death, bleeding, and thromboembolic events (TEs) were derived from the COOL-AF cohort from Thailand and require external validation.
OBJECTIVES
The authors sought to externally validate the COOL-AF scores in the APHRS (Asia-Pacific Heart Rhythm Society) registry and to compare their performance in the ESC-EHRA (European Society of Cardiology-European Heart Rhythm Association) EORP-AF (EURObservational Research Programme in Atrial Fibrillation) General Long-Term Registry.
METHODS
We studied 3,628 APHRS and 8,825 EORP-AF patients. Receiver operating characteristic (ROC) curves and Cox regression analyses were used to test the predictive value of COOL-AF scores and to compared them with the CHADS-VASc and HAS-BLED scores.
RESULTS
Patients in the EORP-AF were older, had a higher prevalence of male sex, and were at higher thromboembolic and hemorrhagic risk than APHRS patients. After 1 year of follow-up in APHRS and EORP-AF, the following events were recorded: 87 (2.4%) and 435 (4.9%) death for any causes, 37 (1.0%) and 111 (1.3%) major bleeding, and 25 (0.7%) and 109 (1.2%) TEs, respectively. In APHRS, the COOL-AF scores showed moderate-to-good predictive value for all-cause mortality (area under the curve [AUC]: 0.77; 95% CI: 0.71-0.83), major bleeding (AUC: 0.68; 95% CI: 0.60-0.76), and TEs (AUC: 0.61; 95% CI: 0.51-0.71), and were similar to the CHADS-VASc and HAS-BLED scores. In EORP-AF, the predictive value of COOL-AF for all-cause mortality (AUC: 0.68; 95% CI: 0.65-0.70) and major bleeding (AUC: 0.61; 95% CI: 0.60-0.62) was modest and lower than in APHRS. In EORP-AF, the COOL-AF score for TE was inferior to the CHADS-VASc score.
CONCLUSIONS
The COOL-AF risk scores may be an easy tool to identify Asian patients with AF at risk for death and major bleeding and performs better in Asian than in European patients with AF. (Clinical Survey on the Stroke Prevention in Atrial Fibrillation in Asia [AF-Registry]; NCT04807049).
背景
房颤患者抗栓治疗与国际标准化比值最佳水平队列研究（COOL - AF）中关于死亡、出血及血栓栓塞事件（TEs）的风险评分源自泰国的COOL - AF队列，需要进行外部验证。
目的
作者试图在亚太心律学会（APHRS）注册研究中对COOL - AF评分进行外部验证，并在欧洲心脏病学会 - 欧洲心律协会（ESC - EHRA）房颤欧洲观察性研究计划（EORP - AF）长期综合注册研究中比较其性能。
方法
我们研究了3628例APHRS患者和8825例EORP - AF患者。采用受试者工作特征（ROC）曲线和Cox回归分析来检验COOL - AF评分的预测价值，并将其与CHADS - VASc和HAS - BLED评分进行比较。
结果
EORP - AF队列中的患者年龄更大，男性患病率更高，血栓栓塞和出血风险高于APHRS队列中的患者。在APHRS和EORP - AF队列中随访1年后，记录到以下事件：任何原因导致的死亡分别为87例（2.4%）和435例（4.9%），大出血分别为37例（1.0%）和111例（1.3%），TEs分别为25例（0.7%）和109例（1.2%）。在APHRS队列中，COOL - AF评分对全因死亡率（曲线下面积[AUC]：0.77；95%置信区间：0.71 - 0.83）、大出血（AUC：0.68；95%置信区间：0.60 - 0.76）和TEs（AUC：0.61；95%置信区间：0.51 - 0.71）显示出中等到良好的预测价值，且与CHADS - VASc和HAS - BLED评分相似。在EORP - AF队列中，COOL - AF对全因死亡率（AUC：0.68；95%置信区间：0.65 - 0.70）和大出血（AUC：0.61；95%置信区间：0.60 - 0.62）的预测价值中等且低于APHRS队列。在EORP - AF队列中，COOL - AF的TE评分低于CHADS - VASc评分。
结论
COOL - AF风险评分可能是识别有死亡和大出血风险的亚洲房颤患者的简便工具，在亚洲患者中比在欧洲房颤患者中表现更好。（亚洲房颤卒中预防临床研究[AF - Registry]；NCT04807049）
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