Comparative Performance of ATRIA, CHADS2, and CHA2DS2-VASc Risk Scores Predicting Stroke in Patients With Atrial Fibrillation Results From a National Primary Care Database
Comparative Performance of ATRIA, CHADS2, and CHA2DS2-VASc Risk Scores Predicting Stroke in Patients With Atrial Fibrillation Results From a National Primary Care Database
复制标题
DOI：
10.1016/j.jacc.2015.08.033
复制
发表时间：
2015-10-27
影响因子：
24
通讯作者：
van Staa, Tjeerd P.
中科院分区：
文献类型：
--
作者：
van den Ham, Hendrika A.;Klungel, Olaf H.;van Staa, Tjeerd P.
背景以前的研究报告CHADS(2)和CHA(2)DS(2)-VASC风险评分具有相似的区分能力(C统计类似于0.6)。目的本研究比较CHA(2)DS(2)-VASC和CHDS(2)缺血性卒中风险评分与Atria卒中风险评分的预测能力及其对房颤患者抗凝治疗的意义。对患者从房颤诊断到发生缺血性中风、服用华法林处方、死亡或研究结束进行追踪。确定了缺血性卒中的独立预测因素，并计算了c指数和净重分类改善。结果共纳入60594名房颤患者。年化卒中发生率为2.99%。CHA(2)DS(2)-VASC的中危和高危类别的事件发生率低于中房和CHADS(2)。年龄和既往中风对缺血性中风的预测作用最强。满分得分的统计数据为：中房风险评分为0.70(95%可信区间：0.69至0.71)，CHADS2为0.68(95%可信区间：0.67至0.69)，CHA(2)DS(2)-VASc风险评分为0.68(95%可信区间：0.67至0.69)。与CHA(2)DS(2)-VASc相比，Atria的净重新分类改善为0.23(95%CI：0.22至0.25)。结论在英国临床实践研究Datalink AF队列中，Atria评分表现更好。它比CHA(2)DS(2)-VASC评分更准确地识别低风险患者，后者将这些患者归入高危类别。这种对卒中风险的重新分类可以防止极低卒中风险的房颤患者过度使用抗凝药物。(C)2015年，由美国心脏病学会基金会提供。
BACKGROUND Previous studies report that CHADS(2) and CHA(2)DS(2)-VASc risk scores have similar discriminating ability (C statistic similar to 0.6). Recently a clinically based risk score, the ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) study risk score, was developed and validated.OBJECTIVES This study compared predictive ability of CHA(2)DS(2)-VASc and CHADS(2) ischemic stroke risk scores with ATRIA stroke risk score and their implications for anticoagulant treatment in patients with atrial fibrillation (AF).METHODS Patients with AF not using warfarin were included from the Clinical Practice Research Datalink database, 1998 to 2012. Patients were followed from AF diagnosis until occurrence of ischemic stroke, prescription of warfarin, death, or the study's end. Independent predictors of ischemic stroke were identified and the c-index and net reclassification improvement were calculated.RESULTS A total of 60,594 patients with AF were included. Annualized stroke rate was 2.99%. Event rates for moderate- and high-risk categories for CHA(2)DS(2)-VASc were lower than those of the ATRIA and CHADS(2). Age and previous stroke most strongly predicted ischemic stroke. C statistics for the full point scores were 0.70 (95% confidence interval [CI]: 0.69 to 0.71) for the ATRIA risk score, 0.68 (95% CI: 0.67 to 0.69) for CHADS2, and 0.68 (95% CI: 0.67 to 0.69) for CHA(2)DS(2)-VASc risk score. The net reclassification improvement was 0.23 (95% CI: 0.22 to 0.25) for ATRIA compared with CHA(2)DS(2)-VASc.CONCLUSIONS The ATRIA score performed better in the U.K. Clinical Practice Research Datalink AF cohort. It more accurately identified low-risk patients than the CHA(2)DS(2)-VASc score, which assigned these patients to higher-risk categories. Such reclassification of stroke risk could prevent overuse of anticoagulants in very low stroke risk patients with AF. (C) 2015 by the American College of Cardiology Foundation.