Meta-analysis of CHADS2 and CHA2DS2-VASc in predicting the stroke and thromboembolism in patients with nonvalvular atrial fibrillation
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摘要: 目的:比较CHADS2和CHA2DS2-VASc评分对非瓣膜性心房颤动(NVAF)患者卒中和血栓栓塞发生风险的预测价值。方法:系统性检索Cochrane图书馆,EMBASE、EBSCO和PubMed数据库中有关CHADS2和CHA2DS2-VASc评分预测NVAF患者卒中和血栓栓塞发生风险的英文文献。采用STATA 12.0软件进行统计分析。结果:本研究共纳入11篇文献。当C-统计量作为连续型变量分析时,CHADS2评分C-统计量分布从0.650到0.717,中位数0.660;CHA2DS2-VASc评分C-统计量分布从0.637到0.724,中位数0.697,合并后C-统计量分别为0.66(0.66~0.67)和0.67(0.66~0.68)。当C-统计量作为分类型变量分析时,CHADS2评分C-统计量分布从0.586到0.722,中位数0.630;CHA2DS2-VASc评分C-统计量分布从0.521到0.850,中位数0.606,合并后C-统计量分别为0.65(0.62~0.67)和0.63(0.59~0.68),但存在高异质性,结果需慎重分析。CHA2DS2-VASc评分低危组的不良事件发生率明显比CHADS2评分低(0.54%:1.40%,P<0.05),且将更多的患者划分到高危组(81.0%:46.0%,P<0.05)。结论:CHADS2和CHA2DS2-VASc评分对NVAF患者卒中和血栓栓塞发生风险的预测价值相类似。但CHA2DS2-VASc评分更容易发现真正“低危”患者,且将更多的患者纳入高危组,有利于指导临床上预防性治疗。
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关键词:
- 心房颤动 /
- CHADS2 /
- CHA2DS2-VASc /
- 卒中 /
- 血栓栓塞
Abstract: Objective:To perform a meta-analysis of comparing the predictive abilities of stroke and thromboembolism between CHADS2 and CHA2DS2-VASc in nonvalvular atrial fibrillation(NVAF) patients.Method:The data were systematically retrieved by searching the Cochrane Library,PubMed and Embase databases to identify relevant cohort studies published in English,which reported the diagnostic performance of both CHADS2 and CHA2DS2-VASc scores.The STATA 12.0software was used to perform the statistical analysis.Result:Eleven studies were included.When analyzed as a continuous variable,the C-statistic ranged from 0.650 to 0.717(median 0.660) for CHADS2 and 0.637 to 0.724(median 0.697) for CHA2DS2-VASc.The pooled C-statistics were0.65(0.62-0.67) and 0.63(0.59-0.68),respectively.When analyzed as a categorical variable,the C-statistic ranged from 0.586 to 0.722(median 0.630) for CHADS2 and 0.521 to 0.850(median 0.606) for CHA2DS2-VASc.The pooled C-statistics were(0.62-0.67) and 0.63(0.59-0.68),respectively.Due to the high heterogeneity across studies,the results should be interpreted cautiously.The average ratio of adverse event in the low-risk group of CHA2DS2-VASc was less than that of CHADS2(0.54% vs 1.40%,P<0.05).The average proportion of the high-risk group of CHA2DS2-VASc was greater than that of CHADS2(81.0% vs 46.0%,P<0.05).Conclusion:The CHADS2 and CHA2DS2-VASc scores indicate similar clinical utility in predicting stroke and thromboembolism.However,the CHA2DS2-VASc score is much more advantageous in identifying extremely low-risk patients with NVAF.It also classifies a greater proportion of patients as high risk.This is beneficial in guiding the clinical preventive treatment.-
Key words:
- CHADS2 /
- CHA2DS2-VASc /
- atrial fibrillation /
- stroke /
- thromboembolism
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[1] LLOYD-JONES D,ADAMS R J,BROWN T M,et al.Executive summary:heart disease and stroke statistics-2010update:a report from the American Heart Association[J].Circulation,2010,121:948-954.
[2] HART R G,PEARCE L A,AGUILAR M I.Metaanalysis:antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation[J].Ann Intern Med,2007,146:857-867.
[3] GAGE B F,WATERMAN A D,SHANNON W,et al.Validation of clinical classification schemes for predicting stroke:results from the National Registry of Atrial Fibrillation[J].JAMA,2001,285:2864-2870.
[4] FUSTER V,RYDEN L E,CANNOM D S,et al.ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation[J].Circulation,2006,114:e257-e354.
[5] CAMM A J,KIRCHHOF P,LIP G Y,et al.Guidelines for the management of atrial fibrillation:the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology(ESC)[J].Eur Heart J,2010,31:2369-2429.
[6] CAMM A J,LIP G Y,DE CATERINA R,et al.2012focused update of the ESC Guidelines for the management of atrial fibrillation:an update of the 2010 ESC Guidelines for the management of atrial fibrillation--developed with the special contribution of the European Heart Rhythm Association[J].Europace,2012,14:1385-1413.
[7] KNOBLOCH K,YOON U,VOGT P M.Preferred reporting items for systematic reviews and meta-analyses(PRISMA)statement and publication bias[J].J Craniomaxillofac Surg,2011,39:91-92.
[8] MCGINN T G,GUYATT G H,WYER P C,et al.Users'guides to the medical literature:XXII:how to use articles about clinical decision rules.EvidenceBased Medicine Working Group[J].JAMA,2000,284:79-84.
[9] CHEN J Y,ZHANG A D,LU H Y,et al.CHADS2versus CHA2DS2-VASc score in assessing the stroke and thromboembolism risk stratification in patients with atrial fibrillation:a systematic review and metaanalysis[J].J Geriatr Cardiol,2013,10:258-266.
[10] LIN L Y,LEE C H,YU C C,et al.Risk factors and incidence of ischemic stroke in Taiwanese with nonvalvular atrial fibrillation-a nation wide database analysis[J].Atherosclerosis,2011,217:292-295.
[11] VAN STAA T P,SETAKIS E,DI TANNA G L,et al.A comparison of risk stratification schemes for stroke in 79,884atrial fibrillation patients in general practice[J].J Thromb Haemost,2011,9:39-48.
[12] FRIBERG L,ROSENQVIST M,LIP G Y.Evaluation of risk stratification schemes for ischaemic stroke and bleeding in 182 678patients with atrial fibrillation:the Swedish Atrial Fibrillation cohort study[J].Eur Heart J,2012,33:1500-1510.
[13] ABRAHAM J M,LARSON J,CHUNG M K,et al.Does CHA2DS2-VASc improve stroke risk stratification in postmenopausal women with atrial fibrillation?[J].Am J Med,2013,126:1141-1143.
[14] GUO Y,APOSTOLAKIS S,BLANN A D,et al.Validation of contemporary stroke and bleeding risk stratification scores in non-anticoagulated Chinese patients with atrial fibrillation[J].Int J Cardiol,2013,168:904-909.
[15] LIP G Y,NIEUWLAAT R,PISTERS R,et al.Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach:the euro heart survey on atrial fibrillation[J].Chest,2010,137:263-272.
[16] LIP G Y,FRISON L,HALPERIN J L,et al.Identifying patients at high risk for stroke despite anticoagulation:a comparison of contemporary stroke risk stratification schemes in an anticoagulated atrial fibrillation cohort[J].Stroke,2010,41:2731-2738.
[17] OLESEN J B,LIP G Y,HANSEN M L,et al.Validation of risk stratification schemes for predicting stroke and thromboembolism in patients with atrial fibrillation:nationwide cohort study[J].BMJ,2011,342:124-128.
[18] POLI D,LIP G Y,ANTONUCCI E,et al.Stroke risk stratification in a "real-world" elderly anticoagulated atrial fibrillation population[J].J Cardiovasc Electrophysiol,2011,22:25-30.
[19] SINGER D E,CHANG Y,BOROWSKY L H,et al.A new risk scheme to predict ischemic stroke and other thromboembolism in atrial fibrillation:the ATRIA study stroke risk score[J].J Am Heart Assoc,2013,2:e250.
[20] AAKRE C A,MCLEOD C J,CHA S S,et al.Comparison of clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation[J].Stroke,2014,45:426-431.
[21] RUIZ-NODAR J M,MARIN F,ROLDAN V,et al.Should we recommend oral anticoagulation therapy in patients with atrial fibrillation undergoing coronary artery stenting with a high HAS-BLED bleeding risk score?[J].Circ Cardiovasc Interv,2012,5:459-466.
[22] GO A S,HYLEK E M,CHANG Y,et al.Anticoagulation therapy for stroke prevention in atrial fibrillation:how well do randomized trials translate into clinical practice?[J].JAMA,2003,290:2685-2692.
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