Tamaki Shunsuke, Higaki Akinori, Kawakami Hiroshi, Nishimura Kazuhisa, Inoue Katsuji, Ikeda Shuntaro, Yamaguchi Osamu, Akashi Naoyuki, Matoba Tetsuya, Kohro Takahide, Kabutoya Tomoyuki, Kario Kazuomi, Kiyosue Arihiro, Nakayama Masaharu, Miyamoto Yoshihiro, Tsujita Kenichi, Fujita Hideo, Nagai Ryozo
Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Japan.
Division of Cardiovascular Medicine, Jichi Medical University Saitama Medical Center, Japan.
Int J Cardiol Cardiovasc Risk Prev. 2025 Jun 20;26:200457. doi: 10.1016/j.ijcrp.2025.200457. eCollection 2025 Sep.
The AHEAD (A: atrial fibrillation; H: hemoglobin; E: elderly; A: abnormal renal parameters; D: diabetes mellitus) score was developed to predict all-cause death (ACD) in patients with heart failure. However, its predictive value for ACD compared to the CHADS score in patients with coronary artery disease (CAD) remains unknown.
This retrospective multicenter cohort study analyzed data of the patients who underwent percutaneous coronary intervention for acute (ACS) or chronic coronary syndromes (CCS) using the Clinical Deep Data Accumulation System (CLIDAS) database. The AHEAD score was calculated by assigning 1 point each for atrial fibrillation, anemia, age >70 years, elevated creatinine levels (>130 μmol/L), and diabetes mellitus.
In total, 9033 patients were enrolled between April 2013 and March 2019. Cox multivariate analysis revealed that both the AHEAD and CHADS scores were independently associated with ACD in patients with ACS and CCS (hazard ratio [HR], 1.91 [95 % CI, 1.70-2.14] for ACS and 1.72 [1.54-1.92] for CCS, and HR 1.17 [1.06-1.29] for ACS and 1.18 [1.08-1.29] for CCS, respectively). However, receiver operating characteristic curve analysis demonstrated that the AHEAD score had a significantly higher predictive value for ACD compared to the CHADS score in both ACS and CCS. A significant difference was found in the rate of ACD among patients stratified by the AHEAD score in both groups.
The AHEAD score demonstrated superior predictive value for ACD compared to the CHADS score in patients with CAD, regardless of whether they had ACS or CCS.
AHEAD（A：心房颤动；H：血红蛋白；E：老年；A：异常肾脏参数；D：糖尿病）评分用于预测心力衰竭患者的全因死亡（ACD）。然而，在冠状动脉疾病（CAD）患者中，与CHADS评分相比，其对ACD的预测价值尚不清楚。
这项回顾性多中心队列研究使用临床深度数据积累系统（CLIDAS）数据库分析了因急性冠状动脉综合征（ACS）或慢性冠状动脉综合征（CCS）接受经皮冠状动脉介入治疗的患者的数据。通过对心房颤动、贫血、年龄>70岁、肌酐水平升高（>130μmol/L）和糖尿病各赋1分来计算AHEAD评分。
2013年4月至2019年3月期间共纳入9033例患者。Cox多变量分析显示，AHEAD评分和CHADS评分均与ACS和CCS患者的ACD独立相关（ACS的风险比[HR]为1.91[95%CI，1.70 - 2.14]，CCS为1.72[1.54 - 1.92]；ACS的HR为1.17[1.06 - 1.29]，CCS为1.18[1.08 - 1.29]）。然而，受试者工作特征曲线分析表明，在ACS和CCS中，AHEAD评分对ACD的预测价值均显著高于CHADS评分。两组中根据AHEAD评分分层的患者的ACD发生率存在显著差异。
在CAD患者中，无论其患有ACS还是CCS，与CHADS评分相比，AHEAD评分对ACD显示出更高的预测价值。
