Validation of clinical classification schemes for predicting stroke - Results from the national registry of Atrial Fibrillation
Validation of clinical classification schemes for predicting stroke - Results from the national registry of Atrial Fibrillation
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DOI：
10.1001/jama.285.22.2864
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发表时间：
2001-06-13
影响因子：
120.7
通讯作者：
Radford, MJ
中科院分区：
文献类型：
--
作者：
Gage, BF;Waterman, AD;Radford, MJ
背景房颤患者发生卒中的风险增加，但其卒中的绝对发生率取决于年龄和合并症。目的评估评估心房颤动患者卒中风险的分类方案的预测价值。设计、设置和患者将两个现有的分类方案合并为新的卒中风险方案CHDS(2)指数，并对所有3个分类方案进行验证。CHADS(2)是由充血性心力衰竭、高血压、75岁或以上的老年人和糖尿病患者各得1分，中风或短暂性脑缺血发作病史各得2分形成的。来自7个州的同行评审组织的数据被用来收集国家房颤登记表(NRAF)，其中包括1733名年龄在65岁到95岁之间的非风湿性房颤的医疗保险受益人，他们在出院时没有服用华法林。主要结果衡量因缺血性中风住院的人数，由医疗保险索赔数据确定。结果在2121例患者年的随访中，94名患者因缺血性中风再次入院(卒中发生率，每100患者年4.4例)。根据大于0.5的a-c统计，现有的两种分类方案对中风的预测优于偶然性：-对于房颤调查者(AFI)开发的方案，c为0.68(95%可信区间[CI]，0.65-0.71)；-c为0.74(95%CI，0.71-0.76)；-c为0.74(95%CI，0.71-0.76)。然而，a-c统计量为0.82(95%CI，0.80-0.84)，CHADS2指数是最准确的卒中预测因子。CHDS评分每增加1分，每100名未接受抗血栓治疗的患者的卒中发生率增加1.5倍(95%CI，1.3-1.7)；(2)评分：0分1.9(95%CI，1.2-3.0)；1分2.8(95%CI，2.0-3.8)；2分4.0(95%CI，3.1-5.1)；3分5.9(95%CI，4.6-7.3)；4例为8.5(95%CI，6.3~11.1)，5例为22.5(95%CI，8.2~17.5)，6例为18.2(95%CI，10.5~27.4)。
Context Patients who have atrial frbrillation (AF) have an increased risk of stroke, but their absolute rate of stroke depends on age and comorbid conditions.Objective To assess the predictive value of classification schemes that estimate stroke risk in patients with AF.Design, Setting, and Patients Two existing classification schemes were combined into a new stroke-risk scheme, the CHADS(2) index, and all 3 classification schemes were validated. The CHADS(2) was formed by assigning 1 point each for the presence of congestive heart failure, hypertension, age 75 years or older, and diabetes mellitus and by assigning 2 points for history of stroke or transient ischemic attack. Data from peer review organizations representing 7 states were used to assemble a National Registry of AF (NRAF) consisting of 1733 Medicare beneficiaries aged 65 to 95 years who had nonrheumatic AF and were not prescribed warfarin at hospital discharge.Main Outcome Measure Hospitalization for ischemic stroke, determined by Medicare claims data.Results During 2121 patient-years of follow-up, 94 patients were readmitted to the hospital for ischemic stroke (stroke rate, 4.4 per 100 patient-years). As indicated by a ----c statistic greater than 0.5, the 2 existing classification schemes predicted stroke better than chance: ---c of 0.68 (95% confidence interval [CI], 0.65-0.71) for the scheme developed by the Atrial Fibrillation Investigators (AFI) and ---c of 0.74 (95% CI, 0.71-0.76) for the Stroke Prevention in Atrial Fibrillation (SPAF) III scheme. However, with a ---c statistic of 0.82 (95% CI, 0.80-0.84), the CHADS2 index was the most accurate predictor of stroke. The stroke rate per 100 patient-years without antithrombotic therapy increased by a factor of 1.5 (95% CI, 1.3-1.7) for each 1-point increase in the CHADS(2) score: 1.9 (95% CI, 1.2-3.0) for a score of 0; 2.8 (95% CI, 2.0-3.8) for 1; 4.0 (95% CI, 3.1-5.1) for 2; 5.9 (95% CI, 4.6-7.3) for 3; 8.5 (95% CI, 6.3-11.1) for 4; 22.5 (95% CI, 8.2-17.5) for 5; and 18.2 (95% CI, 10.5-27.4) for 6.Conclusion The 2 existing classification schemes and especially a new stroke risk index, CHADS(2), can quantify risk of stroke for patients who have AF and may aid in selection of antithrombotic therapy.