Validation of a Modified CHA2DS2-VASc Score for Stroke Risk Stratification in Asian Patients With Atrial Fibrillation: A Nationwide Cohort Study
Validation of a Modified CHA2DS2-VASc Score for Stroke Risk Stratification in Asian Patients With Atrial Fibrillation: A Nationwide Cohort Study
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DOI：
10.1161/strokeaha.116.013880
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发表时间：
2016-10-01
期刊：
影响因子：
8.3
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
背景和目的——房颤患者中风风险增加的年龄阈值对于亚洲人和非亚洲人可能不同。我们假设改良的 CHA(2)DS(2)-VASc（充血性心力衰竭、高血压、年龄 >= 75、糖尿病、既往中风或短暂性脑缺血发作、血管疾病、年龄 65-74 岁、女性）方案 mCHA(2)DS(2)-VASc（为 50 至 74 岁的患者分配 1 分）可能比 CHA(2)DS(2)-VASc 评分在中风风险方面表现更好方法-本研究使用台湾国民健康保险研究数据库，其中包括 224866 名新诊断的房颤患者。在 124271 名未接受抗血栓治疗的患者中，比较了 CHA(2)DS(2)-VASc 和 mCHA(2)DS(2)-VASc 评分对缺血性卒中的预测准确性。在整个队列中，15948 名患者的 CHA(2)DS(2)-VASc 评分为 0（男性）或 1（女性），8654 名患者的 mCHA(2)DS(2)-VASc 评分为 1（男性）或 2（女性）。后者分为3组，即不治疗、抗血小板治疗和华法林，比较缺血性卒中和颅内出血（ICH）的风险。 结果-在538653人年的随访期间，21008名患者经历了缺血性卒中。通过C指数和净重分类指数评估，mCHA(2)DS(2)-VASc评分在预测缺血性卒中方面优于CHA(2)DS(2)-VASc评分。对于因年龄阈值重置而 mCHA(2)DS(2)-VASc 评分为 1（男性）或 2（女性）的 8654 名患者，与不治疗相比，使用华法林与缺血性中风风险降低 30% 相关，并且与 ICH 风险相似。净临床效益分析也有利于在不同加权模型中使用华法林。 结论 - 在这个亚洲房颤队列中，mCHA(2)DS(2)-VASc 评分表现优于 CHA(2)DS(2)-VASc，并将进一步识别可能从口服抗凝剂中获得积极净临床效益的房颤患者。
Background and Purpose-The age threshold for an increased stroke risk for patients with atrial fibrillation may be different for Asians and non-Asians. We hypothesized that a modified CHA(2)DS(2)-VASc (congestive heart failure, hypertension, age >= 75, diabetes mellitus, prior stroke or transient ischemic attack, vascular disease, age 65-74 years, female) scheme, mCHA(2)DS(2)-VASc, which assigned one point for patients aged 50 to 74 years, may perform better than CHA(2)DS(2)-VASc score for stroke risk stratification in Asians.Methods-This study used the Taiwan National Health Insurance Research Database, which included 224866 newly diagnosed atrial fibrillation patients. The predictive accuracies of ischemic stroke of CHA(2)DS(2)-VASc and mCHA(2)DS(2)-VASc scores were compared among 124271 patients without antithrombotic therapies. From the whole cohort, 15948 patients had a CHA(2)DS(2)-VASc score 0 (males) or 1 (females), and 8654 patients had an mCHA(2)DS(2)-VASc score 1 (males) or 2 (females). The latter were categorized into 3 groups, that is, no treatment, antiplatelet therapy, and warfarin, and the risks of ischemic stroke and intracranial hemorrhage (ICH) were compared.Results-During a follow-up of 538653 person-years, 21008 patients experienced ischemic stroke. The mCHA(2)DS(2)-VASc performed better than CHA(2)DS(2)-VASc score in predicting ischemic stroke assessed by C indexes and net reclassification index. For 8654 patients having an mCHA(2)DS(2)-VASc score of 1 (males) or 2 (females) because of the resetting of the age threshold, use of warfarin was associated with a 30% lower risk of ischemic stroke and a similar risk of ICH compared with nontreatment. Net clinical benefit analyses also favored the use of warfarin in different weighted models.Conclusions-In this Asian atrial fibrillation cohort, the mCHA(2)DS(2)-VASc score performed better than the CHA(2)DS(2)-VASc and would further identify atrial fibrillation patients who may derive a positive net clinical benefit from oral anticoagulation.