A new risk scheme to predict ischemic stroke and other thromboembolism in atrial fibrillation: the ATRIA study stroke risk score.
A new risk scheme to predict ischemic stroke and other thromboembolism in atrial fibrillation: the ATRIA study stroke risk score.
复制标题
一种新的风险方案，用于预测房颤中缺血性中风和其他血栓栓塞：Atria研究中风风险评分。
DOI：
10.1161/jaha.113.000250
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发表时间：
2013-06-21
影响因子：
5.4
通讯作者：
Go AS
中科院分区：
文献类型：
--
作者：
Singer DE;Chang Y;Borowsky LH;Fang MC;Pomernacki NK;Udaltsova N;Reynolds K;Go AS
需要更准确和可靠的卒中风险预测工具来优化房颤（AF）患者的抗凝决策。我们使用最初的房颤抗凝和风险因素（ATRIA）AF队列开发了一种新的AF卒中预测模型，并在一个单独的、当代的、基于社区的初始AF队列（ATRIA-心血管研究网络（CVRN）队列）中对评分进行了外部验证。衍生ATRIA队列包括10927例非瓣膜性AF患者，其中32609人-年停用华法林，685例血栓栓塞事件（TE）。外部验证ATRIA-CVRN队列包括25306例AF患者，其中26263人年停用华法林，496例TE。考克斯模型确定了8个变量，年龄、既往卒中、女性、糖尿病、心力衰竭、高血压、蛋白尿和eGFR<45 mL/min/1.73 m2或终末期肾病，加上最终模型的年龄×既往卒中相互作用项。分数与模型系数成比例分配。ATRIA队列的c指数为0.73（95% CI，0.71 - 0.75），仅考虑重度事件时增加至0.76（95% CI，0.74 - 0.79）。在ATRIA-CVRN中，所有事件和重度事件的c-指数分别为0.70（95% CI，0.67 - 0.72）和0.75（95% CI，0.72 - 0.78）。与CHADS 2或CHA 2DS 2-VASc评分相比，ATRIA评分的C-指数更大，净重新分类改善呈阳性。ATRIA卒中风险评分的表现优于现有的风险评分，已成功验证，并在预测严重事件方面有所改善，这是最值得关注的问题。ATRIA评分应改善AF患者的抗血栓决定，并为未来预后模型中添加生物标志物提供安全的基础。
More accurate and reliable stroke risk prediction tools are needed to optimize anticoagulation decision making in patients with atrial fibrillation (AF). We developed a new AF stroke prediction model using the original Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) AF cohort and externally validated the score in a separate, contemporary, community‐based inception AF cohort, ATRIA–Cardiovascular Research Network (CVRN) cohort. The derivation ATRIA cohort consisted of 10 927 patients with nonvalvular AF contributing 32 609 person‐years off warfarin and 685 thromboembolic events (TEs). The external validation ATRIA‐CVRN cohort included 25 306 AF patients contributing 26 263 person‐years off warfarin and 496 TEs. Cox models identified 8 variables, age, prior stroke, female sex, diabetes mellitus, heart failure, hypertension, proteinuria, and eGFR<45 mL/min per 1.73 m2 or end‐stage renal disease, plus an age×prior stroke interaction term for the final model. Point scores were assigned proportional to model coefficients. The c‐index in the ATRIA cohort was 0.73 (95% CI, 0.71 to 0.75), increasing to 0.76 (95% CI, 0.74 to 0.79) when only severe events were considered. In the ATRIA‐CVRN, c‐indexes were 0.70 (95% CI, 0.67 to 0.72) and 0.75 (95% CI, 0.72 to 0.78) for all events and severe events, respectively. The C‐index was greater and net reclassification improvement positive comparing the ATRIA score with the CHADS2 or CHA2DS2‐VASc scores. The ATRIA stroke risk score performed better than existing risk scores, was validated successfully, and showed improvement in predicting severe events, which is of greatest concern. The ATRIA score should improve the antithrombotic decision for patients with AF and should provide a secure foundation for the addition of biomarkers in future prognostic models.