Roles of the CHADS2 and CHA2DS2-VASc scores in post-myocardial infarction patients: Risk of new occurrence of atrial fibrillation and ischemic stroke

被引:36
作者
Lau, Kui-Kai [1 ]
Chan, Pak-Hei [2 ]
Yiu, Kai-Hang [2 ]
Chan, Yap-Hang [2 ]
Liu, Shasha [2 ]
Chan, Koon-Ho [1 ]
Yeung, Chun-Yip [3 ]
Li, Sheung-Wai [4 ]
Tse, Hung-Fat [2 ]
Siu, Chung-Wah [2 ]
机构
[1] Univ Hong Kong, Dept Med, Div Neurol, Hong Kong, Hong Kong, Peoples R China
[2] Univ Hong Kong, Dept Med, Div Cardiol, Hong Kong, Hong Kong, Peoples R China
[3] Univ Hong Kong, Dept Med, Div Endocrinol, Hong Kong, Hong Kong, Peoples R China
[4] Tung Wah Hosp, Dept Med, Hong Kong, Hong Kong, Peoples R China
关键词
CHADS(2); CHA(2)DS(2)-VASc; atrial fibrillation; myocardial infarction; PERCUTANEOUS CORONARY INTERVENTION; ELEVATION MYOCARDIAL-INFARCTION; ASSOCIATION TASK-FORCE; ANTITHROMBOTIC THERAPY; HEART-FAILURE; CARDIAC REHABILITATION; CONSENSUS DOCUMENT; EUROPEAN-SOCIETY; FOCUSED UPDATE; MANAGEMENT;
D O I
10.5603/CJ.a2014.0034
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Patients with myocardial infarction (MI) are at risk of the development of atrial fibrillation (AF) and ischemic stroke. We sought to evaluate the prognostic performance of the CHADS(2) and CHA(2)DS(2)-VASc scores in predicting new AF and/or ischemic stroke in post-ST segment elevation MI (STEMI) patients. Six hundred and seven consecutive post-STEMI patients with no previously documented AF were studied. Methods and Results: After a follow-up of 63 months (3,184 patient-years), 83 (13.7%) patients developed new AF (2.8% per year). Patients with a high CHADS(2) and/or CHA(2)DS(2)-VASc score were more likely to develop new AF. The annual incidence of new AF was 1.18%, 2.10%, 4.52%, and 7.03% in patients with CHADS(2) of 0, 1, 2, and >= 3; and 0.39%, 1.72%, 1.83%, and 5.83% in patients with a CHA(2)DS(2)-VASc score of 1, 2, 3 and >= 4. The CHA(2)DS(2)-VASc score (C-statistic = 0.676) was superior to the CHADS(2) (C-statistic = 0.632) for discriminating new AF. Ischemic stroke occurred in 29 patients (0.9% per year), the incidence increasing in line with the CHADS(2) (0.41%, 1.02%, 1.11%, and 1.95% with score of 0, 1, 2, and >= 3) and CHA(2)DS(2)-VASc scores (0.39%, 0.49%, 1.02%, and 1.48% with score of 1, 2, 3 and = 4). The C-statistic of the CHA(2)DS(2)-VASc score as a predictor of ischemic stroke was 0.601, superior to that of CHADS(2) score (0.573). CHADS(2) and CHA(2)DS(2)-VASc scores can identify post-STEMI patients at high risk of AF and stroke. Conclusions: The CHADS(2) and CHA(2)DS(2)-VASc scores can identify post-STEMI patients at high risk of AF and ischemic stroke. This enables close surveillance and prompt anticoagulation for stroke prevention.
引用
收藏
页码:474 / 483
页数:10
相关论文
共 35 条
[1]   2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines [J].
Anderson, Jeffrey L. ;
Adams, Cynthia D. ;
Antman, Elliott M. ;
Bridges, Charles R. ;
Califf, Robert M. ;
Casey, Donald E., Jr. ;
Chavey, William E., II ;
Fesmire, Francis M. ;
Hochman, Judith S. ;
Levin, Thomas N. ;
Lincoff, A. Michael ;
Peterson, Eric D. ;
Theroux, Pierre ;
Wenger, Nanette Kass ;
Wright, R. Scott ;
Ettinger, Steven M. ;
Ganiats, Theodore G. ;
Jneid, Hani ;
Philippides, George J. ;
Zidar, James Patrick ;
Jacobs, Alice K. ;
Albert, Nancy ;
Hochman, Judith S. ;
Creager, Mark A. ;
Kushner, Frederick G. ;
Ohman, Erik Magnus ;
Guyton, Robert A. ;
Stevenson, William G. ;
Halperin, Jonathan L. ;
Yancy, Clyde W. .
CIRCULATION, 2011, 123 (18) :E426-E579
[2]   INDEPENDENT RISK-FACTORS FOR ATRIAL-FIBRILLATION IN A POPULATION-BASED COHORT - THE FRAMINGHAM HEART-STUDY [J].
BENJAMIN, EJ ;
LEVY, D ;
VAZIRI, SM ;
DAGOSTINO, RB ;
BELANGER, AJ ;
WOLF, PA .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1994, 271 (11) :840-844
[3]   Anticoagulation in patients with atrial fibrillation undergoing coronary stent implantation [J].
Bernard, Anne ;
Fauchier, Laurent ;
Pellegrin, Celine ;
Clementy, Nicolas ;
Saint Etienne, Christophe ;
Banerjee, Amitava ;
Naudin, Djedjiga ;
Angoulvant, Denis .
THROMBOSIS AND HAEMOSTASIS, 2013, 110 (03) :560-568
[4]  
Camm AJ, 2010, EUROPACE, V12, P1360, DOI [10.1093/europace/euq350, 10.1093/eurheartj/ehq278]
[5]   A Clinical Risk Score for Atrial Fibrillation in a Biracial Prospective Cohort (from the Atherosclerosis Risk In Communities [ARIC] Study) [J].
Chamberlain, Alanna M. ;
Agarwal, Sunil K. ;
Folsom, Aaron R. ;
Soliman, Elsayed Z. ;
Chambless, Lloyd E. ;
Crow, Richard ;
Ambrose, Marietta ;
Alonso, Alvaro .
AMERICAN JOURNAL OF CARDIOLOGY, 2011, 107 (01) :85-91
[6]   Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events (ACTIVE W): a randomised controlled trial [J].
Connolly, S. ;
Pogue, J. ;
Hart, R. ;
Pfeffer, M. ;
Hohnloser, S. ;
Chrolavicius, S. ;
Yusuf, S. .
LANCET, 2006, 367 (9526) :1903-1912
[7]   Prevalence of atrial fibrillation in the general population and in high-risk groups: the ECHOES study [J].
Davis, Russell C. ;
Hobbs, F. D. Richard ;
Kenkre, Joyce E. ;
Roalfe, Andrea K. ;
Iles, Rachel ;
Lip, Gregory Y. H. ;
Davies, Michael K. .
EUROPACE, 2012, 14 (11) :1553-1559
[8]   Prevention of atrial fibrillation in patients with symptomatic chronic heart failure by candesartan in the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) program [J].
Ducharme, Anique ;
Swedberg, Karl ;
Pfeffer, Marc A. ;
Cohen-Solal, Alain ;
Granger, Christopher B. ;
Maggioni, Aldo P. ;
Michelson, Eric L. ;
McMurray, John J. V. ;
Olsson, Lars ;
Rouleau, Jean L. ;
Young, James B. ;
Olofsson, Bertil ;
Puu, Margareta ;
Yusuf, Salim .
AMERICAN HEART JOURNAL, 2006, 152 (01) :86-92
[9]   Consensus Document: Antithrombotic therapy in patients with atrial fibrillation undergoing coronary stenting A North-American perspective [J].
Faxon, David P. ;
Eikelboom, John W. ;
Berger, Peter B. ;
Holmes, David R. ;
Bhatt, Deepak L. ;
Moliterno, David J. ;
Becker, Richard C. ;
Angiolillo, Dominick J. .
THROMBOSIS AND HAEMOSTASIS, 2011, 106 (04) :572-584
[10]   ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society [J].
Fuster, Valentin ;
Ryden, Lars E. ;
Cannom, David S. ;
Crijns, Harry J. ;
Curtis, Anne B. ;
Ellenbogen, Kenneth A. ;
Halperin, Jonathan L. ;
Le Heuzey, Jean-Yves ;
Kay, G. Neal ;
Lowe, James E. ;
Olsson, S. Bertil ;
Prystowsky, Eric N. ;
Tamargo, Juan Luis ;
Wann, Samuel .
CIRCULATION, 2006, 114 (07) :E257-E354