Relationship of Aging and Incident Comorbidities to Stroke Risk in Patients With Atrial Fibrillation
Relationship of Aging and Incident Comorbidities to Stroke Risk in Patients With Atrial Fibrillation
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DOI：
10.1016/j.jacc.2017.10.085
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发表时间：
2018-01-16
影响因子：
24
通讯作者：
Chen, Shih-Ann
中科院分区：
文献类型：
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作者：
Chao, Tze-Fan;Lip, Gregory Y. H.;Chen, Shih-Ann
背景：在评估房颤患者的缺血性卒中风险时，根据基线危险因素计算CHA(2)DS(2)-VASc评分，并在一段随访期后确定结果。然而，房颤患者的卒中风险并不是一成不变的，随着时间的推移，患者年龄越来越大，并积累了更多的并发症。目的本研究假设，与基线CHA(2)DS(2)-VASc评分相比，反映基线和随访之间评分变化的Delta CHA(2)DS(2)-VASc评分更能预测缺血性中风。Delta CHA(2)DS(2)-VASC评分被定义为基线和随访CHA(2)DS(2)-VASC评分之间的差值。在171,956人年期间，4103名患者经历了缺血性中风。结果基线CHA(2)DS(2)-VASc评分平均为1.29，随访期间增加到2.31，Delta CHA(2)DS(2)-VASc评分平均为1.02。只有40.8%的患者CHA(2)DS(2)-VASC评分保持不变。在4103名经历过缺血性卒中的患者中，89.4%的患者有Delta CHA(2)DS(2)-VASc评分<gt；=1，而在非缺血性卒中患者中这一比例仅为54.6%，2,643例(64.4%)患者有<gt；=1新发并发症，最常见的是高血压。通过C指数和净重分类指数评估，Delta CHA(2)DS(2)-VASc评分是表现优于基线或随访CHA(2)DS(2)-VASc评分的显著预测因子。结论在这个房颤队列中，作者证明CHA(2)DS(2)-VASc评分不是静态的，大多数房颤患者在出现缺血性中风之前出现了>；=1个新的卒中危险因素。Delta CHA(2)DS(2)-VASc评分反映了基线和随访之间评分的变化，对缺血性中风有很强的预测作用，反映了由于年龄和并发症的增加，房颤的中风风险是一个动态过程。(C)2018年，由美国心脏病学院基金会提供。
BACKGROUND When assessing ischemic stroke risk in patients with atrial fibrillation (AF), the CHA(2)DS(2)-VASc score is calculated based on the baseline risk factors, and the outcomes are determined after a follow-up period. However, the stroke risk in patients with AF does not remain static, and with time, patients get older and accumulate more comorbidities.OBJECTIVES This study hypothesized that the "Delta CHA(2)DS(2)-VASc score," which reflects the change in score between baseline and follow-up, would be more predictive of ischemic stroke compared with the baseline CHA(2)DS(2)-VASc score.METHODS A total of 31,039 patients with AF who did not receive antiplatelet agents or oral anticoagulants, and who did not have comorbidities of the CHA(2)DS(2)-VASc score except for age and sex, were studied. The Delta CHA(2)DS(2)-VASc scores were defined as the differences between the baseline and follow-up CHA(2)DS(2)-VASc scores. During 171,956 person-years, 4,103 patients experienced ischemic stroke. The accuracies of baseline, follow-up, and Delta CHA(2)DS(2)-VASc scores in predicting ischemic stroke were analyzed and compared.RESULTS The mean baseline CHA(2)DS(2)-VASc score was 1.29, which increased to 2.31 during the follow-up, with a mean Delta CHA(2)DS(2)-VASc score of 1.02. The CHA(2)DS(2)-VASc score remained unchanged in only 40.8% of patients. Among 4,103 patients who experienced ischemic stroke, 89.4% had a Delta CHA(2)DS(2)-VASc score >= 1 compared with only 54.6% in patients without ischemic stroke, and 2,643 (64.4%) patients had >= 1 new-onset comorbidity, the most common being hypertension. The Delta CHA(2)DS(2)-VASc score was a significant predictor of ischemic stroke that performed better than baseline or follow-up CHA(2)DS(2)-VASc scores, as assessed by the C-index and the net reclassification index.CONCLUSIONS In this AF cohort, the authors demonstrated that the CHA(2)DS(2)-VASc score was not static, and that most patients with AF developed >= 1 new stroke risk factor before presentation with ischemic stroke. The Delta CHA(2)DS(2)-VASc score, reflecting the change in score between baseline and follow-up, was strongly predictive of ischemic stroke, reflecting how stroke risk in AF is a dynamic process due to increasing age and incident comorbidities. (c) 2018 by the American College of Cardiology Foundation.