CHADS2, CHA2DS2-VASc and R2CHADS2 scores predict mortality in patients with coronary artery disease
CHADS2, CHA2DS2-VASc and R2CHADS2 scores predict mortality in patients with coronary artery disease
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CHADS(2)、CHA(2)DS(2)-VASc 和 R(2)CHADS(2) 评分可预测冠状动脉疾病患者的死亡率
DOI：
10.1007/s11739-017-1608-x
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发表时间：
2017-06-01
影响因子：
4.6
通讯作者：
Chen, Mao
中科院分区：
文献类型：
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作者：
Huang, Fang-Yang;Huang, Bao-Tao;Chen, Mao
迄今为止，很少有研究涉及CHA(2)DS(2)-VASc和R(2)CHADS(2)在CAD患者中的预测能力。我们的目的是探讨冠心病（CAD）患者CHADS(2)、CHA(2)DS(2)-VASc和R(2)CHADS(2)评分对预后的影响。纳入了血管造影阻塞性CAD患者。使用Cox风险模型评估三种风险评分的预后表现。此外，我们通过计算C统计量、净重分类改善（NRI）和综合歧视改善（IDI）来比较它们的预测值。终点是任何原因死亡和心血管死亡。在3295例CAD患者中，CHADS(2)、CHA(2)DS(2)- vasc和R(2)CHADS(2)的平均得分分别为1.2 +/- 1.0、2.4 +/- 1.4和1.6 +/- 1.4。CHADS(2)引导的风险分类与CHA(2)DS-(2)- vasc -和R(2)CHADS(2)引导的风险分类明显不同。在中位随访24个月期间，共发生290例（比率4.00/100人年）死亡，163例（比率2.2/100人年）死于心血管疾病。CHADS(2)、CHA(2)、DS(2)-VASc和R(2)CHADS(2)的事件发生率增加（P < 0.001）。多变量分析显示CHADS(2)、CHA(2)、DS(2)-VASc和R(2)CHADS(2)评分每单位增加死亡风险分别高出60%、111和82%。与CHADS(2)评分（c-statistic = 0.61）相比，CHA(2)DS(2)-VASc （c-statistic 0.65, NRI 0.52, IDI 0.06， P均< 0.05）和R(2)CHADS(2) （c-statistic 0.66, NRI 0.43, IDI 0.09， P均< 0.05）评分能更好地区分和重新分类死亡率。此外，CHA(2)DS(2)-VASc和R(2)CHADS(2)对死亡率的预测能力与GRACE评分相当。CHADS(2)、CHA(2)DS(2)-VASc和R(2)CHADS(2)评分是CAD患者简单而可靠的预后工具。
Few studies to date address the predictive ability of CHA(2)DS(2)-VASc and R(2)CHADS(2) in CAD patients. Our aim is to investigate the prognostic performance of CHADS(2), CHA(2)DS(2)-VASc and R(2)CHADS(2) scores in patients with coronary artery disease (CAD). Angiographically obstructive CAD patients were enrolled. The prognostic performance of the three risk scores was evaluated using Cox hazards models. In addition, we compared their predictive values by calculating C statistics, net reclassification improvement (NRI) and integrated discrimination improvement (IDI). The endpoints are death from any cause and cardiovascular death. Of 3295 subjects with CAD, the mean CHADS(2), CHA(2)DS(2)-VASc and R(2)CHADS(2) scores are 1.2 +/- 1.0, 2.4 +/- 1.4, and 1.6 +/- 1.4, respectively. The CHADS(2)-guided risk classification is markedly distinct from CHA(2)DS-(2)-VASc- and R(2)CHADS(2)-guided ones. Over a median follow-up of 24 months, a total of 290 (rate 4.00/100 person-year) deaths occurred, and 163 (rate 2.2/100 person-year) were attributed to cardiovascular deaths. Event rates increase by CHADS(2), CHA(2)DS(2)-VASc and R(2)CHADS(2) (P for trend < 0.001). The multivariate analyses show 60, 111 and 82% higher risk of mortality per unit increase of CHADS(2), CHA(2)DS(2)-VASc and R(2)CHADS(2) scores, respectively. Comparing with CHADS(2) score (c-statistic = 0.61), CHA(2)DS(2)-VASc (c-statistic 0.65, NRI 0.52 and IDI 0.06, P for all < 0.05) and R(2)CHADS(2) (c-statistic 0.66, NRI 0.43 and IDI 0.09, P for all < 0.05) scores provide better discrimination and reclassification for mortality. Also, CHA(2)DS(2)-VASc and R(2)CHADS(2) have comparable predictive ability of mortality to the GRACE score. The CHADS(2), CHA(2)DS(2)-VASc and R(2)CHADS(2) scores are simple yet robust prognostic tools in CAD patients.