A Clinical Score for Predicting Atrial Fibrillation in Patients with Cryptogenic Stroke or Transient Ischemic Attack
A Clinical Score for Predicting Atrial Fibrillation in Patients with Cryptogenic Stroke or Transient Ischemic Attack
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DOI：
10.1159/000476030
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发表时间：
2017-01-01
期刊：
影响因子：
1.9
通讯作者：
Shah, Nigam H.
中科院分区：
文献类型：
--
作者：
Kwong, Calvin;Ling, Albee Y.;Shah, Nigam H.
目的：在隐源性卒中（CS）或短暂性脑缺血发作（TIA）后患者中检测心房颤动（AF）具有重要的治疗意义。研究方法：为了对CS/TIA患者进行风险分层，以预防以后发生AF，我们使用斯坦福大学转化研究综合数据库环境（STRIDE）中1995年至2015年的数据进行了一项回顾性队列研究。结果：在纳入的9，589例CS/TIA成人患者（年龄≥ 40岁）中，482例（5%）患者在CS/TIA后发生AF。在这些患者中，分别有28.4%、26.3%和45.3%的患者在指数CS/TIA后1-12个月、1-3年和>3年被诊断为AF。年龄（>= 75岁）、肥胖、充血性心力衰竭、高血压、冠状动脉疾病、外周血管疾病和瓣膜疾病是显著的危险因素，其各自的比值比（95%CI）如下：1.73（1.39-2.16）、1.53（1.05-2.18）、3.34（2.61-4.28）、2.01（1.53-2.68）、1.72（1.35-2.19）、1.37（1.02-1.84）和2.05（1.55-2.69）。风险评分系统，即，HAVOC评分使用这7个临床变量构建，其成功地将患者分层为3个风险组，具有良好的模型区分（曲线下面积= 0.77）。结论：本研究的结果支持在CS/TIA后患者中寻找更长时间和更难的AF的策略。HAVOC评分可识别不同程度的AF风险，并可用于选择患者进行延长心律监测。(C)2017 S. Karger AG，巴塞尔
Objectives: Detection of atrial fibrillation (AF) in post-cryptogenic stroke (CS) or transient ischemic attack (TIA) patients carries important therapeutic implications. Methods: To risk stratify CS/TIA patients for later development of AF, we conducted a retrospective cohort study using data from 1995 to 2015 in the Stanford Translational Research Integrated Database Environment (STRIDE). Results: Of the 9,589 adult patients (age >= 40 years) with CS/TIA included, 482 (5%) patients developed AF post CS/TIA. Of those patients, 28.4, 26.3, and 45.3% were diagnosed with AF 1-12 months, 1-3 years, and >3 years after the index CS/TIA, respectively. Age (>= 75 years), obesity, congestive heart failure, hypertension, coronary artery disease, peripheral vascular disease, and valve disease are significant risk factors, with the following respective odds ratios (95% CI): 1.73 (1.39-2.16), 1.53 (1.05-2.18), 3.34 (2.61-4.28), 2.01 (1.53-2.68), 1.72 (1.35-2.19), 1.37 (1.02-1.84), and 2.05 (1.55-2.69). A risk-scoring system, i.e., the HAVOC score, was constructed using these 7 clinical variables that successfully stratify patients into 3 risk groups, with good model discrimination (area under the curve = 0.77). Conclusions: Findings from this study support the strategy of looking longer and harder for AF in post-CS/TIA patients. The HAVOC score identifies different levels of AF risk and may be used to select patients for extended rhythm monitoring. (C) 2017 S. Karger AG, Basel