Mo Ran, Yang Yan-Min, Zhang Han, Suo Ni, Wang Jing-Yang, Lyu Si-Qi
Emergency Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China.
National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China.
Rev Cardiovasc Med. 2022 May 11;23(5):168. doi: 10.31083/j.rcm2305168. eCollection 2022 May.
Early risk stratification of patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI) has relevant implication for individualized management strategies. The -VASc and GRACE ACS risk model are well-established risk stratification systems. We aimed to assess their prognostic performance in AF patients with ACS or PCI.
Consecutive patients with AF and ACS or referred for PCI were prospectively recruited and followed up for 3 years. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCEs), including cardiovascular mortality, myocardial infarction, ischemic stroke, systemic embolism and ischemia-driven revascularization.
Higher -VASc (HR [hazard ratio] 1.184, 95% CI 1.091-1.284) and GRACE at discharge score (HR 1.009, 95% CI 1.004-1.014) were independently associated with increased risk of MACCEs. The -VASc (c-statistics: 0.677) and GRACE at discharge (c-statistics: 0.699) demonstrated comparable discriminative capacity for MACCEs ( = 0.281) while GRACE at admission provided relatively lower discrimination (c-statistics: 0.629, vs. -VASc = 0.041). For predicting all-cause mortality, three models displayed good discriminative capacity (c-statistics: 0.750 for -VASc, 0.775 for GRACE at admission, 0.846 for GRACE at discharge). A significant discrimination improvement of GRACE at discharge compared to -VASc was detected (NRI = 45.13%).
In the setting of coexistence of AF and ACS or PCI, -VASc and GRACE at discharge score were independently associated with an increased risk of MACCEs. The GRACE at discharge performed better in predicting all-cause mortality.
心房颤动（AF）合并急性冠状动脉综合征（ACS）或接受经皮冠状动脉介入治疗（PCI）患者的早期风险分层对个体化管理策略具有重要意义。-VASc和GRACE ACS风险模型是成熟的风险分层系统。我们旨在评估它们在AF合并ACS或PCI患者中的预后性能。
前瞻性招募连续的AF合并ACS患者或接受PCI治疗的患者，并随访3年。主要终点是主要不良心血管和脑血管事件（MACCEs），包括心血管死亡、心肌梗死、缺血性中风、全身性栓塞和缺血驱动的血运重建。
较高的-VASc（风险比[HR]1.184，95%可信区间1.091-1.284）和出院时的GRACE评分（HR 1.009，95%可信区间1.004-1.014）与MACCEs风险增加独立相关。-VASc（c统计量：0.677）和出院时的GRACE（c统计量：0.699）对MACCEs的判别能力相当（=0.281），而入院时的GRACE判别能力相对较低（c统计量：0.629，与-VASc相比P=0.041）。对于预测全因死亡率，三种模型均显示出良好的判别能力（-VASc的c统计量：0.750，入院时GRACE的c统计量：0.775，出院时GRACE的c统计量：0.846）。与-VASc相比，出院时GRACE的判别能力有显著提高（净重新分类指数[NRI]=45.13%）。
在AF与ACS或PCI并存的情况下，-VASc和出院时的GRACE评分与MACCEs风险增加独立相关。出院时的GRACE在预测全因死亡率方面表现更好。
