R₂-CHA₂DS₂-VASc Score for Cardiovascular Event Prediction After Bioprosthetic Valve Replacement　- Subanalysis From the BPV-AF Registry.

Circulation reports Pub Date : 2024-06-29 eCollection Date: 2024-08-09 DOI:10.1253/circrep.CR-24-0033

Madoka Sano, Misa Takegami, Masashi Amano, Hidekazu Tanaka, Kenji Ando, Takeshi Kitai, Makoto Miyake, Tatsuhiko Komiya, Masaki Izumo, Hiroya Kawai, Kiyoyuki Eishi, Kiyoshi Yoshida, Takeshi Kimura, Ryuzo Nawada, Tomohiro Sakamoto, Yoshisato Shibata, Toshihiro Fukui, Kenji Minatoya, Kenichi Tsujita, Yasushi Sakata, Kumiko Sugio, Tadaaki Koyama, Tomoyuki Fujita, Kunihiro Nishimura, Chisato Izumi, Yutaka Furukawa

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Abstract

Background: There are few studies evaluating the prognostic prediction method in atrial fibrillation (AF) patients after bioprosthetic valve (BPV) replacement. The R₂-CHA₂DS₂-VASc score is increasingly used for the prediction of cardiovascular (CV) events in patients with AF, device implantation, and acute coronary syndrome. We aimed to evaluate the predictive value of the R₂-CHA₂DS₂-VASc score for future CV events in AF patients after BPV replacement.

Methods and results: The BPV-AF, an observational, multicenter, prospective registry, enrolled AF patients who underwent BPV replacement. The primary outcome measure was a composite of stroke, systemic embolism, CV events including heart failure requiring hospitalization, and cardiac death. A total of 766 patients was included in the analysis. The mean R₂-CHA₂DS₂-VASc score was 5.7±1.8. Low (scores 0-1), moderate (scores 2-4), and high (scores 5-11) R₂-CHA₂DS₂-VASc score groups consisted of 12 (1.6%), 178 (23.2%), and 576 (75.2%) patients, respectively. The median follow-up period was 491 (interquartile range 393-561) days. Kaplan-Meier analysis showed a higher incidence of the composite CV events in the high R₂-CHA₂DS₂-VASc score group (log rank test; P<0.001). Multivariate Cox proportional hazards regression analysis revealed that the R₂-CHA₂DS₂-VASc score as a continuous variable was an independent predictor of composite CV outcomes (hazard ratio 1.36; 95% confidence interval 1.18-1.55; P<0.001).

Conclusions: The R₂-CHA₂DS₂-VASc score is useful for CV risk stratification in AF patients after BPV replacement.

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用于预测生物人工瓣膜置换术后心血管事件的 R2-CHA2DS2-VASc 评分 - BPV-AF 登记的子分析。

背景：很少有研究对生物瓣膜置换术后心房颤动（房颤）患者的预后预测方法进行评估。R2-CHA2DS2-VASc评分越来越多地被用于预测房颤、装置植入和急性冠脉综合征患者的心血管（CV）事件。我们旨在评估 R2-CHA2DS2-VASc 评分对房颤患者更换 BPV 后未来 CV 事件的预测价值：BPV-AF是一项观察性、多中心、前瞻性登记项目，登记了接受BPV置换术的房颤患者。主要结局指标是中风、全身性栓塞、心血管事件（包括需要住院治疗的心力衰竭）和心源性死亡的复合指标。共有 766 名患者被纳入分析。平均 R2-CHA2DS2-VASc 得分为 5.7±1.8。R2-CHA2DS2-VASc评分低（0-1分）、中（2-4分）和高（5-11分）组分别由12（1.6%）、178（23.2%）和576（75.2%）名患者组成。随访时间中位数为 491 天（四分位数间距为 393-561 天）。Kaplan-Meier分析显示，R2-CHA2DS2-VASc评分高的组别发生复合CV事件的几率更高（对数秩检验；作为连续变量的P2-CHA2DS2-VASc评分是复合CV结局的独立预测因子（危险比1.36；95%置信区间1.18-1.55；PC结论：R2-CHA2DS2-VASc评分高的组别发生复合CV事件的几率更高）：R2-CHA2DS2-VASc评分可用于房颤患者置换 BPV 后的 CV 风险分层。

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