Validation of risk stratification schemes for predicting stroke and thromboembolism in patients with atrial fibrillation: nationwide cohort study.
Validation of risk stratification schemes for predicting stroke and thromboembolism in patients with atrial fibrillation: nationwide cohort study.
复制标题
对心房颤动患者预测中风和血栓栓塞的风险分层方案的验证：全国同伴研究。
DOI：
10.1136/bmj.d124
复制
发表时间：
2011-01-31
期刊：
影响因子：
--
通讯作者：
Torp-Pedersen C
中科院分区：
文献类型：
--
作者：
Olesen JB;Lip GY;Hansen ML;Hansen PR;Tolstrup JS;Lindhardsen J;Selmer C;Ahlehoff O;Olsen AM;Gislason GH;Torp-Pedersen C
目的评价CHADS 2（充血性心力衰竭、高血压、年龄≥75岁、糖尿病、既往卒中）评分和CHA 2DS 2-VASc（CHA 2DS 2-血管疾病、年龄65-74岁、性别分类）评分的个体危险因素，并计算各方案预测血栓栓塞的能力。设计基于登记的队列研究。全国范围内因房颤入院的患者数据。人群：1997-2006年期间丹麦所有未接受维生素K拮抗剂治疗的房颤患者。主要结局指标卒中和血栓栓塞。结果121280例非瓣膜性房颤患者中，73538例（60.6%）符合纳入标准。在“低风险”患者（评分=0）中，1年随访时，CHADS 2组每100人年的血栓栓塞率为1.67（95%置信区间1.47至1.89），CHA 2DS 2-VASc组为0.78（0.58至1.04）。在“中等风险”（评分=1）的患者中，CHADS 2组的该比率为4.75（4.45至5.07），CHA 2DS 2-VASc组为2.01（1.70至2.36）。血栓栓塞发生率取决于构成评分的个体风险因素，两种方案均低估了与既往血栓栓塞事件相关的风险。当患者被分为低、中和高风险组时，CHADS 2组10年随访时的C统计量为0.812（0.796至0.827），CHA 2DS 2-VASc组为0.888（0.875至0.900）。结论与特定危险分层评分相关的风险取决于构成评分的危险因素。CHA 2DS 2-VASc在预测高风险患者方面优于CHADS 2，并且那些被CHA 2DS 2-VASc归类为低风险的患者确实处于血栓栓塞的低风险中。
Objectives To evaluate the individual risk factors composing the CHADS2 (Congestive heart failure, Hypertension, Age≥75 years, Diabetes, previous Stroke) score and the CHA2DS2-VASc (CHA2DS2-Vascular disease, Age 65-74 years, Sex category) score and to calculate the capability of the schemes to predict thromboembolism. Design Registry based cohort study. Setting Nationwide data on patients admitted to hospital with atrial fibrillation. Population All patients with atrial fibrillation not treated with vitamin K antagonists in Denmark in the period 1997-2006. Main outcome measures Stroke and thromboembolism. Results Of 121 280 patients with non-valvular atrial fibrillation, 73 538 (60.6%) fulfilled the study inclusion criteria. In patients at “low risk” (score=0), the rate of thromboembolism per 100 person years was 1.67 (95% confidence interval 1.47 to 1.89) with CHADS2 and 0.78 (0.58 to 1.04) with CHA2DS2-VASc at one year’s follow-up. In patients at “intermediate risk” (score=1), this rate was 4.75 (4.45 to 5.07) with CHADS2 and 2.01 (1.70 to 2.36) with CHA2DS2-VASc. The rate of thromboembolism depended on the individual risk factors composing the scores, and both schemes underestimated the risk associated with previous thromboembolic events. When patients were categorised into low, intermediate, and high risk groups, C statistics at 10 years’ follow-up were 0.812 (0.796 to 0.827) with CHADS2 and 0.888 (0.875 to 0.900) with CHA2DS2-VASc. Conclusions The risk associated with a specific risk stratification score depended on the risk factors composing the score. CHA2DS2-VASc performed better than CHADS2 in predicting patients at high risk, and those categorised as low risk by CHA2DS2-VASc were truly at low risk for thromboembolism.