CHADS2及CHA2DS2-VASc评分在冠心病外科治疗中的应用

目的：评价CHADS2及CHA2DS2-VASc评分系统在冠心病外科治疗中的意义。 方法：选择2006年1月至2010年1月行不停跳冠状动脉旁路移植术的768个病人,术后新发房颤患者97例,回顾病人的围术期及随访资料,应用CHADS2及CHA2DS2-VASc评分系统,进行分析。 结果：分为术后新发房颤组与非房颤组。术后新发房颤发生率12.6%。平均年龄70.74±8.21岁和65.90±9.83岁,围术期脑卒中8例和9例,CHADS2评分值分别为3.2±1.26和2.13±0.94,CHA2DS2-VASc评分值分别为4.2±1.50和3.23±1.07,CHADS2和CHA2DS2-VASc评分是术后新发房颤的预测因素,与围术期脑卒中显著相关,P < 0.01。 结论：冠心病外科治疗中应用CHADS2及CHA2DS2-VASc评分系统可预测术后新发房颤及围术期脑卒中,对冠心病术后新发房颤的抗凝及抗血小板治疗决策提供了依据,对卒中风险及预后有一定的评估价值。     

CHA2DS2-VASc score as a novel predictor for contrast-induced nephropathy after percutaneous coronary intervention in acute coronary syndrome

BackgroundCHA2DS2-VASc score, used for atrial fibrillation to assess the risk of embolic complications, have shown to predict adverse clinical outcomes in acute coronary syndrome (ACS), irrespective of atrial fibrillation. This study envisaged to assess the predictive role of CHA2DS2-VASc score for contrast-induced nephropathy (CIN) in patients with ACS undergoing percutaneous coronary intervention (PCI).MethodsA total of 300 consecutive patients with ACS undergoing PCI were enrolled in this study. CHA2DS2-VASc score was calculated for each patient. These patients were divided into two groups as Group 1 (with CIN) and Group 2 (without CIN). CIN was defined as increase in serum creatinine level ≥0.5 mg/dL or ≥25% increase from baseline within 48 h after PCI. After receiver operating characteristic curve analysis, the study population was again classified into two groups: CHA2DS2-VASc score ≤3 group (Group A) and score ≥4 group (Group B).ResultsCIN was reported in 41 patients (13.6%). Patients with CIN had a higher frequency of hypertension, diabetes mellitus, and had a lower left ventricular ejection fraction and baseline estimated glomerular filtration rate. Receiver operating characteristic curve analysis showed good predictive value of CHA2DS2-VASc score for CIN (area under the curve 0.81, 95% CI 0.73–0.90). Patients with a CHA2DS2-VASc score of ≥4 had a higher frequency of CIN as compared with patients with score ≤3 (56.8% vs 4.8%; p = 0.0001) with multivariate analysis demonstrating CHA2DS2-VASc score of ≥4 to be an independent predictor of CIN.ConclusionIn patients with ACS undergoing PCI, CHA2DS2-VASc score can be used as a novel, simple, and a sensitive diagnostic tool for the prediction of CIN.     

CHA2DS2-VASc score is a useful-predictor of not prognosis but coronary-arteriosclerosis in chronic atrial-fibrillation compared with CHADS2 score: A two-center study of 320-slice CT,part 2

Background

The aim of this study is to predict the risk of coronary-arteriosclerosis and prognosis in subjects with chronic-atrial-fibrillation (CAF) using the CHADS2 and CHA2DS2-VASc scores by 320-slice-CT and invasive-coronary-angiography (ICA) in a two-center-study.

Methods

53 CAF subjects who underwent 320-slice-CT and ICA within 6-months (43 male; 69 ± 9 years; CHADS2 score 2.2 ± 1.3; CHA2DS2-VASc score 3.5 ± 1.6) in the two-institutes were analyzed. CT and ICA data were transferred to the analysis-center and were analyzed by cardiologists.

Results

Agatston-calcium-score and frequencies of the presence of various-kinds of plaques and > 50% and > 75% coronary artery stenosis were significantly higher in the subjects with CHA2DS2-VASc score ≥ 3 compared with those with score < 3. However there were no-significant differences in the Agatston-calcium-score and frequencies of the presence of various-kinds of plaques and > 50% and > 75% coronary artery stenosis evaluated by 320-slice CT between the subjects with CHADS2 score ≥ 2 and < 2. Frequency of > 50% coronary artery stenosis by ICA was significantly higher in the subjects with CHA2DS2-VASc score ≥ 3 compared with those with score < 3. However, there were no-significant differences in the frequencies of > 50% and > 75% coronary artery stenosis by ICA between the subjects with CHADS2 score ≥ 2 and < 2. During a mean of 15.9 months, composite rate of cardiac death and heart failure did not differ between subjects with CHADS2 score ≥ 2 and score < 2 and between subjects with CHA2DS2-VASc score ≥ 3 and score < 3.

Conclusions

The CHA2DS2-VASc score is a useful predictor of not prognosis but coronary-arteriosclerosis in subjects with CAF compared with CHADS2 score in this two-center-study.     

北京市高同型半胱氨酸血症伴低CHA2DS2-VASc非瓣膜性心房颤动PCI患者的预后分析

目的分析北京市高同型半胱氨酸血症(HHcy)伴CHA2DS2-VASc≤1的非瓣膜性心房颤动(NVAF)-经皮冠状动脉介入(PCI)患者的预后。方法选择CHA2DS2-VASc=0或1的NVAF-PCI患者共1 688例,评估其主要不良心血管事件的风险及影响因素。依据入院时同型半胱氨酸水平分为对照组(n=1 135, Hcy15μmol/L)和HHcy组(n=553, Hcy≥15μmol/L)。主要终点是MACE事件的发生。结果随访1年,HHcy组MACE事件发生率较高(P=0.017),HHcy组缺血性卒中的发生率明显高于对照组(P=0.009),两组心因死亡(P=0.046)及非致死性心肌梗死(P=0.044)的发生率差异有显著性。结论 HHcy增加CHA2DS2-VASc≤1 NVAF-PCI患者的MACE事件尤其是缺血性卒中的发生,提示这类患者接受抗凝治疗可能临床获益较大。     

Relationship between changes in platelet reactivity and ischemic events following percutaneous coronary intervention: A meta-regression analysis of 30 randomized trials

Objective

High on-treatment platelet reactivity (HPR) is a well-known risk factor for adverse events in patients undergoing percutaneous coronary intervention (PCI). However, whether reducing platelet reactivity can lead to a lower incidence of ischemic events after PCI is still controversial. Therefore, we sought to investigate this issue by a meta-regression analysis of randomized trials.

Methods

We collected randomized trials reporting HPR rates in patients receiving different antiplatelet therapies. ΔHPR was defined as the difference between HPR rates achieved in control vs. experimental arms, and the relationship between ΔHPR and clinical outcomes was evaluated.

Results

Thirty trials totalling 6683 patients with a mean follow-up of 3-month were included. Reducing platelet reactivity was associated to a decreased risk of major adverse cardiac events (MACE), with a linear relationship between ΔHPR and MACE (change in tau² = −2.50; p = 0.023). Particularly, achieving a 10% difference in HPR rates resulted in a parallel risk reduction in MACE of about 11% (Exp^(b) = 0.98; 95% CI, 0.97–0.99).Changes in HPR predict the risk of ischemic events in patients with acute coronary syndrome (change in tau² = −2.52; Exp^(b) = 0.98; 95% CI, 0.97–0.99; p = 0.03), but not in patients with poor response to clopidogrel (change in tau² = −1.44; Exp^(b) = 0.98; 95% CI, 0.96–1.01; p = 0.19) or stable coronary artery disease (change in tau² = −0.14; Exp^(b) = 0.99; 95% CI, 0.94–1.05; p = 0.89).

Conclusion

Reducing HPR occurrence decreases the risk of ischemic events in patients with acute coronary syndrome undergoing PCI, whereas a strategy of reducing platelet reactivity does not improve clinical outcomes in patients with poor response to clopidogrel or stable coronary artery disease.     

Utility of short-term telemetry heart rhythm monitoring and CHA2DS2-VASc stratification in patients presenting with suspected cerebrovascular accident

BACKGROUNDInpatient telemetry heart rhythm monitoring overuse has been linked to higher healthcare costs. AIMTo evaluate if CHA₂DS₂-VASc score could be used to indicate if a patient admitted with possible cerebrovascular accident (CVA) or transient ischemic attack (TIA) requires inpatient telemetry monitoring. METHODSA total of 257 patients presenting with CVA or TIA and placed on telemetry monitoring were analyzed retrospectively. We investigated the utility of telemetry monitoring to diagnose atrial fibrillation/flutter and the CHA₂DS₂-VASc scoring tool to stratify the risk of having CVA/TIA in these patients.RESULTSIn our study population, 63 (24.5%) of the patients with CVA/TIA and telemetry monitoring were determined to have no ischemic neurologic event. Of the 194 (75.5) patients that had a confirmed CVA/TIA, only 6 (2.3%) had an arrhythmia detected during their inpatient telemetry monitoring period. Individuals with a confirmed CVA/TIA had a statistically significant higher CHA₂DS₂-VASc score compared to individuals without an ischemic event (3.59 vs 2.61, P < 0.001). CONCLUSIONGiven the low percentage of inpatient arrhythmias identified, further research should focus on discretionary use of inpatient telemetry on higher risk patients to diagnose the arrhythmias commonly leading to CVA/TIA. A prospective study assessing event rate of CVA/TIA in patients with higher CHA₂DS₂-VASc score should be performed to validate the CHA₂DS₂-VASc score as a possible risk stratifying tool for patients at risk for CVA/TIA.     

CHADS2, CHA2DS2-VASc,ATRIA, and Essen stroke risk scores in stroke with atrial fibrillation: A nationwide multicenter registry study

The performance of scoring systems for risk stratification in patients with atrial fibrillation (AF) was not validated well in patients with stroke. The purpose of this study was to evaluate whether the risk scoring systems predict vascular outcomes in stroke patients with AF.Data were obtained from a nationwide multicenter registry for acute stroke with AF from January 1, 2013, to December 31, 2015. We investigated the predictive power of the CHADS₂, CHA₂DS₂-VASc, ATRIA, and Essen stroke scores in stroke patients with AF. The subjects were further stratified into groups according to treatment with or without oral anticoagulants (OACs).A total of 3112 stroke with AF subjects were included. The rate of recurrent ischemic stroke and any stroke were not associated with the CHADS₂, CHA₂DS₂-VASc, ATRIA, and Essen stroke risk scores. The risks of death and major adverse cerebrovascular and cardiovascular events (MACEs) increased sequentially with the increase of each risk score in OAC group. (the range of C-index 0.544–0.558 for recurrent ischemic stroke; 0.523–0.537 for any stroke; 0.580–0.597 for death; 0.564–0.583 for MACEs). However, in the group treated with OACs, all risk scores were significantly associated with the risk of MACEs. The C-statistics of the 4 scoring systems were 0.544 to 0.558, 0.523 to 0.537, 0.580 to 0.597, 0.564 to 0.583, respectively, for recurrent ischemic stroke, any stroke, death, and MACEs.The performance of the CHADS₂, CHA₂DS₂-VASc, ATRIA, and Essen stroke risk scores for the prediction of recurrent stroke was unsatisfactory in stroke patients with AF whereas the performance for the prediction of recurrent stroke was not MACEs or death was good. A new risk stratification scheme that is specific for secondary stroke prevention in the AF population is needed.     

Study on the predictive ability of emergency CHADS2 score and CHA2DS2-VASc score for coronary artery disease and prognosis in patients with acute ST-segment elevation myocardial infarction

BackgroundAcute ST-segment elevation myocardial infarction (STEMI) has a high morbidity and mortality rate. The congestive heart failure, hypertension, age, diabetes, previous stroke/transient ischemic attack (2 points) (CHADS₂) and CHADS₂ score with 2 points assigned for age >75 years-vascular disease (CHA₂DS₂-VASc) scores are widely used for risk stratification management of non-valvular atrial fibrillation stroke and have high prognostic value in cardiovascular disease. This study aims to investigate the predictive value of the emergency CHADS₂ and CHA₂DS₂-VASc score on coronary artery lesions and prognosis in patients with acute STEMI.MethodsA total of 524 patients with STEMI from May 2018 to October 2021 were selected for emergency CHADS₂ and CHA₂DS₂-VASc. Clinical data and laboratory indicators were collected. Patients were evaluated for coronary artery disease (CAD) and prognosis. Logistic regression and the receiver operating characteristic (ROC) curve were used to analyze the data.ResultsIn severe group, CysC levels, CHADS₂, CHA₂DS₂-VASc score and the proportion of diabetes, stroke or transient ischemic attack (TIA), congestive heart failure, smoking history, Killip class ≥2 was higher than that in mild and moderate group. In poor prognosis group, levels of serum creatinine (Crea), CysC, hemoglobin (Hb), CHADS₂, CHA₂DS₂-VASc score and the proportion of hypertension, diabetes, stroke or TIA, congestive heart failure, smoking history, and Killip class ≥2 was higher than that in good prognosis group. Diabetes (OR, 3.678; 95% CI: 2.876–5.872, 0.008), CHADS₂ (OR, 3.829; 95% CI: 2.310–5.832, 0.003) and CHA₂DS₂-VASc score (OR, 4.671; 95% CI: 3.125–6.187, 0.000) were independent risk factors for the severity of CAD (P<0.05). Diabetes (OR, 3.287; 95% CI: 2.231–5.123, 0.012), Killip class ≥2 (OR, 2.212; 95% CI: 1.023–2.987, 0.045), LVEF (OR, 3.110; 95% CI: 2.124–5.031, 0.023), CHADS₂ (OR, 3.228; 95% CI: 2.133–5.886, 0.005) and CHA₂DS₂-VASc score (OR, 3.988; 95% CI: 2.987–5.873, 0.001) were independent risk factors for prognosis of acute STEMI patients. Area under curve (AUC) value of CHA₂DS₂-VASc score in evaluating CAD and prognosis was 0.947, 0.931, higher than that of the CHADS₂ score (0.836, 0.812) (P<0.05).ConclusionsMultiple factors jointly affect the severity and prognosis of CAD in patients with acute STEMI. The CHA₂DS₂-VASc score is better than the CHADS₂ score in predicting the severity of coronary artery lesions and prognosis of patients, providing theoretical support for clinical practice.     

Clinical safety profile of ticagrelor compared to clopidogrel in 1208 patients: Real world evidence

Introduction

Dual antiplatelet treatment is recommended by current clinical practice guidelines for patients undergoing PCI. The PLATO trial showed superiority of ticagrelor to clopidogrel in reducing the rate of death from vascular causes, myocardial infarction and stroke without increase in the rate of overall major bleeding in ACS patients. However, real world evidence in Indian patients is limited. The objective of this study is to compare safety profile of ticagrelor with clopidogrel in real world settings.

Thromboembolic risk evaluation in patients with atrial fibrillation using a modified CHADS(2) scoring system

Thromboembolic Risk Stratification in AF. Background : Antithrombotic recommendations for relatively low risk patients with atrial fibrillation (AF) are not well established. Some patients with CHADS₂ score = 0 have a CHA₂DS₂–VASc score of 2, which indicated warfarin therapy in the latter system. We evaluated the thromboembolic risk in AF patients with a CHADS₂ score of 0 or 1. Methods: A total of 695 patients with AF that were followed for ≥ 12 months (median 65.6 months, range 12–138 months), were analyzed retrospectively. The modified CHADS₂ score (MCS) was applied as follows. Each CHADS₂ score group was divided into 2 groups, A and B (i.e., MCS 0A vs 0B, and MCS 1A vs 1B) according to the number of nonmajor risk factors (female gender, chronic kidney disease, coronary artery disease, age 65–74 years). Group A had 0 or 1, and group B had 2 or more nonmajor risk factors. Results: In patients with CHADS₂ score = 1, there were 13 thromboembolic events (0.65%/year) in 343 MCS 1A patients, and 12 thromboembolic events (1.90%/year) in 108 MCS 1B patients. Thromboembolic risk was significantly higher in the MCS 1B compared to the MCS 1A patients (P = 0.006). In 244 patients with CHADS₂ score = 0, the thromboembolic risk of MCS 0B was similar to that of MCS 0A (P = 0.095), and 26 patients had a CHA₂DS₂–VASc score of 2. Conclusion: Patients with MCS 1B had a higher thromboembolic risk than patients with MCS 1A. Antithrombotic strategies for patients with a CHA₂DS₂–VASc score of 2 but a CHADS₂ score of 0 need further investigation. J Cardiovasc Electrophysiol, Vol. 23, pp. 155‐162, February 2012)     

CHA2DS2-VASc score predicts the slow flow/no-reflow phenomenon in ST-segment elevation myocardial infarction patients with multivessel disease undergoing primary percutaneous coronary intervention

ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease (MVD) have a higher incidence of slow-flow/no-reflow (SF-NR) phenomenon during primary percutaneous coronary intervention (PPCI) than those with single vessel disease. Currently, no effective tools exist to predict the risk of SF-NR in this population. The present study aimed to evaluate whether CHA₂DS₂-VASc score can be used as a simple tool to predict this risk.This study consecutively included STEMI patients hospitalized in Beijing Anzhen Hospital from January 2005 to January 2015. Among these patients, 1032 patients with MVD were finally enrolled. Patients were divided into SF-NR (+) group and SF-NR (–) group according to whether SF-NR occurred during PPCI. SF-NR was defined as the thrombolysis in myocardial infarction (TIMI) grade ≤2.There were 134 patients (13%) in the SF-NR (+) group. Compared with the SF-NR (–) group, patients in the SF-NR (+) group are elder, with lower left ventricular ejection fraction and higher CHA₂DS₂-VASc score. Multiple logistic regression analysis indicated that CHA₂DS₂-VASc score ≥3 (odds ratio [OR], 2.148; 95% confidence interval [CI], 1.389–3.320; P = .001), current smoking (OR, 1.814; 95% CI, 1.19–2.764; P = .006), atrial fibrillation (OR, 2.892; 95% CI, 1.138–7.350; P = .03), complete revascularization (OR, 2.307; 95% CI, 1.202–4.429; P = .01), and total length of stents ≥40 mm (OR, 1.482; 95% CI, 1.011–2.172; P = .04) were independent risk factors of SF-NR. The incidence of SF-NR in patients with CHA₂DS₂-VASc score ≥3 was 1.7 times higher than that in patients with CHA₂DS₂-VASc score <3. Additionally, patients with CHA₂DS₂-VASc score ≥3 plus ≥2 risk factors have 3 times higher incidence of SF-NR than those with CHA₂DS₂-VASc score ≥3 plus 0 to 1 risk factor.CHA₂DS₂-VASc score ≥3 can be used as a simple and sensitive indicator to predict SF-NR phenomenon and guide the PPCI strategy in STEMI patients with MVD.     

Assessment of the charlson comorbidity index score,CHADS2 and CHA2DS2-VASc scores in predicting death in patients with thoracic empyema

Background

Patients with thoracic empyema have an increased risk of mortality, but their absolute rate of mortality depends on age and comorbidities.

三种评分对心房颤动导管消融术后复发的预测价值比较

目的 探讨CAAP-AF评分、APPLE评分及CHA2DS2-VASc评分对房颤导管消融术后复发的预测价值。方法 纳入2014年1月至2017年6月在中国医科大学附属第一医院行房颤消融术的251例患者并进行术后随访,根据术后3个月后是否再次发生任何持续至少30秒的房性心律失常,将患者分为复发组和未复发组。分别计算每位患者CAAP-AF评分、APPLE评分及CHA2DS2-VASc评分分值,并对评分及一般资料等结果进行统计学分析。结果 三种评分对房颤导管消融术后复发均有一定预测价值,随着评分的增高,复发率逐渐增高;其中CAAP-AF评分的预测价值最佳,其最佳截断点为≥5分,灵敏度为65.1%,特异度为65.5%。其余评分预测价值之间无统计学差异。Logistic回归分析表明,CAAP-AF评分及CHA2DS2-VASc评分为房颤消融术后复发的独立危险因素。结论 三种评分对房颤消融术后复发均有一定预测价值,其中CAAP-AF评分预测价值最佳。     

Predictors of high on-clopidogrel platelet reactivity in patients with acute coronary syndrome

High on-clopidogrel platelet reactivity (HPR) is a predictor of ischemic events after percutaneous coronary intervention. We conducted a prospective cohort study to identify variables related to HPR in acute coronary syndrome patients who are at high thrombotic risk. We enrolled 463 patients undergoing urgent coronary angiography. Platelet reactivity was measured 12–36 hours after 600?mg clopidogrel loading with multiple electrode aggregometry (Multiplate® analyzer, Roche, Basel, Switzerland, 6.4?µM ADP). HPR was defined by the consensus cut-off area under the curve >46?U. The rate of HPR was 16.0%. We analyzed simple clinical and laboratory parameters with backward multivariate logistic regression and identified the following predictors of HPR: platelet count (per G/L, OR: 1.0073, 95% CI: 1.0035–1.0112, p?=?0.0002), CRP level (per mg/L, OR: 1.0077, 95% CI: 1.0016–1.01372, p?=?0.01), and active smoking (OR: 0.51, 95% CI: 0.29–0.89, p?=?0.02). We developed and internally validated a risk prediction model demonstrating moderate discriminative capacity (area-under-the-receiver operating characteristic curve?=?0.67). In conclusion, we found a relatively low rate of high on-clopidogrel platelet reactivity (16.0%) even in an acute patient cohort. HPR measured by Multiplate was associated with high platelet count and CRP level on admission and was inversely related to active smoking. The model with rapidly available simple parameters might help to identify individuals at risk for HPR in the acute setting.