■心房颤动(AF)是临床上最常见的心律失常,它与死亡风险增加有关,中风,和外周栓塞。房颤患者的卒中风险是异质性的,并且取决于当前风险分层方案中包括的潜在临床状况。最近,CHA2DS2-VASc评分已纳入指南,纳入常规临床实践中观察到的常见卒中危险因素.本研究旨在研究CHA2DS2-VASc评分对房颤患者预后的预测价值,以确定房颤患者口服抗凝和抗血小板聚集药物与主要并发症包括脑梗死和颅内出血的相关性,并确定全因死亡的危险因素。
对2020年1月至2020年12月在海安曲堂中心医院接受体检的181例房颤患者进行了前瞻性研究。病人的一般情况,慢性病史,CHA2DS2-VASc[充血性心力衰竭,高血压,年龄≥75岁(加倍),糖尿病,行程(加倍),血管疾病,年龄65至74岁,和性别类别(女性)]得分,左心室射血分数(LVEF),脂质代谢,记录体格检查期间的口服抗凝和抗血小板聚集药物。通过使用电话会议来完成后续工作,我们追踪了病人的脑梗塞,颅内出血,随访2年内生存状况,统计分析房颤并发症与用药的关系,并根据CHA2DS2-VASc评分对房颤患者进行分组,以评估其对这些患者死亡结局的预测能力.
■根据用药情况将患者分为四组,联合用药组脑梗死发生率明显低于非用药组(0.0%vs.19.2%;P<0.01)。联合用药组颅内出血发生率明显高于非用药组(13.8%vs.0.0%;P<0.01)。Logistic回归模型显示,有脑梗死病史的患者死亡风险高于无脑梗死病史的患者[比值比(OR)=7.404;95%置信区间(CI):2.255-24.309]。根据CHA2DS2-VASc评分分组后,我们发现CHA2DS2-VASc评分<5的患者与评分≥5的患者的2年生存率差异有统计学意义(P<0.01)。参与者的特征曲线分析表明,CHA2DS2-VASc评分对房颤患者的全因死亡率具有良好的预测能力(曲线下面积=0.754),截止值为4,灵敏度为62.50%,特异性为86.06%,95%CI为0.684-0.815。
■CHA2DS2-VASc评分显示出房颤患者全因死亡率的高预测价值。
UNASSIGNED: Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia encountered in clinical practice, and it is associated with an increased risk of mortality, stroke, and peripheral embolism. The risk of stroke in AF is heterogeneous and dependent on underlying clinical conditions included in current risk stratification schemes. Recently, the CHA2DS2-VASc score has been incorporated into guidelines to encompass common stroke risk factors observed in routine clinical practice. The aim of this study was to study the predictive value of CHA2DS2-VASc score on the prognosis of patients with AF to determine the correlation of major complications including cerebral infarction and intracranial hemorrhage in patients with AF with oral anticoagulant and antiplatelet aggregation drugs and to identify the risk factors for all-cause mortality.
UNASSIGNED: A prospective study was conducted on 181 patients with AF who underwent physical examinations at Hai\'an Qutang Central Hospital from January 2020 to December 2020. The patient\'s general condition, chronic disease history, CHA2DS2-VASc [congestive heart failure, hypertension, age ≥75 years (doubled), diabetes, stroke (doubled), vascular disease, age 65 to 74 years, and sex category (female)] score, left ventricular ejection fraction (LVEF), lipid metabolism, and oral anticoagulant and antiplatelet aggregation medication during physical examination were recorded. By using telephone meetings to complete the follow-up, we tracked the patient\'s cerebral infarction, intracranial hemorrhage, and survival status within 2 years of follow-up, statistically analyzed the relationship between AF complications and medication, and grouped patients with AF based on the CHA2DS2-VASc score to evaluate its predictive ability for mortality outcomes in these patients.
UNASSIGNED: The patients were divided into four groups according to the medication situation, and the incidence of cerebral infarction in the combination group was significantly lower than that in the non-medication group (0.0% vs. 19.2%; P<0.01). The incidence of intracranial hemorrhage in the combination group was significantly higher than that in the non-drug group (13.8% vs. 0.0%; P<0.01). The logistic regression model indicated that patients with a history of cerebral infarction had an increased risk of death compared to those without a history of cerebral infarction [odds ratio (OR) =7.404; 95% confidence interval (CI): 2.255-24.309]. After grouping according to the CHA2DS2-VASc score, we found that there was a significant difference in the 2-year survival rate between patients with CHA2DS2-VASc score <5 and those with a score ≥5 (P<0.01). The characteristic curve analysis of the participants showed that the CHA2DS2-VASc score had good predictive ability for all-cause mortality in patients with AF (area under the curve =0.754), with a cutoff value of 4, a sensitivity of 62.50%, a specificity of 86.06%, and a 95% CI of 0.684-0.815.
UNASSIGNED: The CHA2DS2-VASc score demonstrated high predictive value for all-cause mortality in patients with AF.