新发房颤患者缺血性卒中风险不同方法评估

目的比较CHADS₂和CHA₂DS₂-VASc 2种评分方法对心房颤动(房颤)人群的缺血性脑卒中风险评估的差异。方法采用前瞻性队列研究方法,对143例新发非瓣膜性房颤患者,用CHADS₂和CHA₂DS₂-VASc 2种评分方法进行卒中风险评估,比较2种评估方法得分以及卒中危险分层的差异。结果CHADS₂平均得分为(1.51±1.28)分,CHA₂DS₂-VASc平均得分为(2.36±1.97)分,后者明显高于前者(P<0.01);CHA₂DS₂-VASc评分低危组19例(13.3%),低于CHADS₂评分低危组的46例(32.2%)(χ²=11.21,P<0.01);CHA₂DS₂-VASc评分中危组的32例(22.4%),低于CHADS₂评分中危组42例(29.4%)(χ²=4.57,P<0.01);CHA₂DS₂-VASc评分高危组的92例(64.3%),高于CHADS₂评分高危组55例(38.5%)(χ²=20.76,P<0.01);CHADS₂评分法中,低度、中度、高度风险组,脑卒中发生例数分别为1、2、3例;CHA₂DS₂-VASc评分法中,低度、中度、高度风险组脑卒中发生例数分别为0、0、6例。结论与CHADS₂评分法比较,CHA₂DS₂-VASc评估卒中风险中、低危组比例降低,高危组比例升高。

Risk of ischemic stroke among newly diagnosed non-valvular atrial fibrillation patients:assessment based on CHADS2 and CHA2DS2-VASc score

ObjectiveTo compare the results of ischemic stroke risk assessment in patients with newly diagnosed non-valvular atrial fibrillation(AF) using CHADS₂(congestive heart failure,hypertension,age≥75 years,diabetes,prior stroke or transient ischemic attack or thromboembolism[doubled]) and CHA₂DS₂-VASc(congestive heart failure,hypertension,age≥75 years[doubled],diabetes,prior stroke or transient ischemic attack or thromboembolism[doubled],vascular disease,age 65-74 years,sex category) classification schemes for the appropriate application of the schemes among Chinese patients.MethodsWith prospective cohort design,the stroke risk of 143 patients with newly diagnosed non-valvular atrial fibrillation were assessed using CHADS₂ and CHA₂DS₂-VASc score and the results of assessment with the two schemes were compared.ResultsThe average score of CHA₂DS₂-VASc was significantly higher than that of CHADS₂(2.36±1.97 vs.1.51±1.28,P<0.01).Based on the scores of CHADS₂,the proportions of the patients with low,intermediate,and high stroke risk were 32.2%(46/143),29.4%(42／143),and 38.5%(55/143),while based on the scores of CHA₂DS₂-VASc,the proportions were 13.3%(19/143),22.4%(32/143),and 64.3%(92/143),respectively,with a significantly lower proportion of low stroke risk(χ²=4.57,P<0.01)and a significantly higher proportion of high stoke risk(χ²=20.76,P<0.05) for using CHA₂DS₂-VASc compared to using CHADS₂.During the two-year follow-up,the number of stroke incident in the patients with low,intermediate,and high stroke risk assessed with CHADS₂ were 1,2,and 3,whereas the number were 0,0,6 assessed with CHA₂DS₂-VASc,respectively.ConclusionCompared to with CHADS₂,stroke risk assessment with CHA₂DS₂-VASc results in a lower proportion of low risk and a higher proportion of high risk among newly diagnosed Chinese non-valvular AF patients.