Stroke risk scores for prediction of mortality and hemorrhages in atrial fibrillation patients

IF 1.6 Q2 MEDICINE, GENERAL & INTERNAL Romanian Journal of Internal Medicine Pub Date : 2022-06-10 DOI:10.2478/rjim-2022-0009
A. Ivănescu, C. Delcea, G. Dan
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引用次数: 1

Abstract

Abstract Background: Atrial fibrillation (AF) is an emerging epidemic worldwide, responsible for a twofold increase in mortality, independent of other risk factors. Stroke prevention is the cornerstone of AF management. However, oral anticoagulation imposes an increased risk of bleeding. Several risk scores have been developed for estimating both the thromboembolic and the bleeding risks. The aim of the study was to determine the usefulness of different stroke risk scores as predictors of mortality and hemorrhagic events in AF patients. Methods: We retrospectively enrolled 211 AF patients hospitalized in the Cardiology Ward of our tertiary hospital. The primary endpoints were mortality and non-minor bleeding events. The mean follow-up period was 378 days for bleeding events and 5 years and 1 month for mortality. For each patient, we evaluated the following stroke risk scores: CHADS2, CHA2DS2-VASc, R2CHADS2, ABC, ATRIA, GARFIELD. Results: The mean age in our cohort is 66, with a slight predominance of women (52.2%). For a CHA2DS2-VASc ≥ 4 as well as for a score of 2-3, 5-year survival was worse than for patients with a score of 0–1(chi-squared=8.13; p=0.01). Similarly, all subgroups of patients with an ABC <2%, had a worse 5-year survival when compared with an ABC score of ≥2% (chi-squared=12.85; p=0.005). C-statistics show a modest predictive value for mortality, for all stroke scores except Garfield, with similar AUCs, the highest being for CHA2DS2-VASc (AUC 0.656; p=0.0001). CHA2DS2-VASc also correlates with bleeding events, having a good predictive ability (AUC 0.723; 95%CI 0.658–0.782, p=0.001), mildly superior to HAS-BLED (AUC 0.674; 95% CI 0.523–0.825; p = 0.04) and very close to Garfield-bleeding (0.765; 95%CI 0.702–0.80; p=0.0001). Conclusions: CHA2DS2-VASc is comparable to HAS-BLED and Garfield-bleeding in predicting bleeding events in AF patients. CHA2DS2-VASc and ABC correlate directly and consistently with mortality rate. For CHA2DS2-VASc, the AUCs for our endpoints are similar to the ones for stroke prediction, highlighting the potential of extending its applicability to various outcomes.
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预测房颤患者死亡率和出血的卒中风险评分
背景:房颤(AF)是一种新兴的全球流行病,其死亡率增加了两倍,独立于其他危险因素。卒中预防是房颤管理的基石。然而,口服抗凝剂会增加出血的风险。已经开发了几种风险评分来评估血栓栓塞和出血风险。该研究的目的是确定不同卒中风险评分作为房颤患者死亡率和出血性事件预测因子的有效性。方法:回顾性分析我院三级医院心内科住院的房颤患者211例。主要终点是死亡率和非轻微出血事件。出血事件的平均随访时间为378天,死亡的平均随访时间为5年零1个月。对于每位患者,我们评估了以下卒中风险评分:CHADS2, CHA2DS2-VASc, R2CHADS2, ABC,心房,GARFIELD。结果:本组患者的平均年龄为66岁,女性略占优势(52.2%)。对于CHA2DS2-VASc≥4以及评分为2-3的患者,5年生存率低于评分为0-1的患者(卡方=8.13;p = 0.01)。同样,与ABC评分≥2%的患者相比,ABC评分<2%的所有亚组患者的5年生存率都较差(卡方=12.85;p = 0.005)。c -统计数据显示,除Garfield外,所有卒中评分对死亡率的预测价值不大,AUC相似,最高的是CHA2DS2-VASc (AUC 0.656;p = 0.0001)。CHA2DS2-VASc也与出血事件相关,具有良好的预测能力(AUC 0.723;95%CI 0.658-0.782, p=0.001),略优于HAS-BLED (AUC 0.674;95% ci 0.523-0.825;p = 0.04),非常接近加菲猫出血(0.765;95%可信区间0.702 - -0.80;p = 0.0001)。结论:CHA2DS2-VASc在预测AF患者出血事件方面与HAS-BLED和Garfield-bleeding相当。CHA2DS2-VASc和ABC与死亡率直接一致相关。对于CHA2DS2-VASc,我们的终点的auc与卒中预测的auc相似,这突出了将其扩展到各种结果的适用性的潜力。
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来源期刊
Romanian Journal of Internal Medicine
Romanian Journal of Internal Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
3.20
自引率
5.30%
发文量
35
审稿时长
15 weeks
期刊介绍: Romanian Journal of Physics is a journal publishing physics contributions on the following themes: •Theoretical Physics & Applied Mathematics •Nuclear Physics •Solid State Physics & Materials Science •Statistical Physics & Quantum Mechanics •Optics •Spectroscopy •Plasma & Lasers •Nuclear & Elementary Particles Physics •Atomic and Molecular Physics •Astrophysics •Atmosphere and Earth Science •Environment Protection
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