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Eur Heart J:预测缺血性卒中发生的风险:ATRIA评分优于CHADS2和CHA2DS2-VASc

2016-05-31 phylis 译 MedSci原创

目的:心房颤动(AF)患者中,对是否应用抗凝药物治疗进行优化,以更好地进行脑卒中风险预测。两大加利福尼亚社区AF队列开发并验证了ATRIA卒中风险评分(ATRIA)的开发和验证。研究者应用比较瑞典国家AF(SAF)队列比较ATRIA, CHADS2和CHA2DS2-VASc评分。方法:研究者检查了所有瑞典住院治疗或医院门诊的患者,这些患者在2005年7月到2010年12月诊断为AF。从综合的国家数

目的:在房颤(AF)患者中,对是否应用抗凝药物治疗进行优化,以更好地进行脑卒中风险预测。两个加利福尼亚社区AF队列中的ATRIA卒中风险评分(ATRIA)的开发和验证。研究者把它与瑞典国家AF(SAF)队列比较ATRIA、CHADS2和CHA2DS2-VASc评分。

方法:研究者检查了所有瑞典住院治疗或医院门诊的患者,这些患者在2005年7月到2010年12月诊断为AF。从综合的国家数据库中确定变量。应用C-指数和净重新分类改善(NRI)评估危险分数。

结果:该队列包括152153名未接受华法林治疗的房颤患者。总体而言,11053例发生急性缺血性中风,平均速度为3.2% /年,高于加利福尼亚队列的2% /年。使用整个分数,ATRIA的C指数较好 0.708(0.704-0.713),明显优于CHADS2 0.690(0.685-0.695)或CHA2DS2-VASc 0.694(0.690-0.700)。使用低/中/高风险的界值点,ATRIA的C指数虽有所降低但仍优于其他分数。与CHADS2相比,净重新分类改善为ATRIA 0.16(0.14-0.17),与CHA2DS2-VASc相比,净重新分类改善为0.21(0.20-0.23)。当设置界值点以更好地适应人群的卒中发生率时,净重新分类改善降低。

结论:在这个SAF队列中,ATRIA分数预测缺血性卒中风险优于CHADS2和CHA2DS2-VASc。然而,人群卒中率不同,评分的相对性能的也不同。可能需要优化设置的界值点分数,以更好地适应当地人口的卒中率。

原始出处:

Aspberg S, Chang Y, et al. Comparison of the ATRIA, CHADS2, and CHA2DS2-VASc stroke risk scores in predicting ischaemic stroke in a large Swedish cohort of patients with atrial fibrillation. Eur Heart J. 2016 Mar 3.


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    2017-07-05 1e145228m78(暂无匿称)

    学习了,谢谢作者分享!

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  4. 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beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2818, encryptionId=1c292818fd, topicName=ASC)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=quxin068, createdTime=Tue Aug 09 20:52:00 CST 2016, time=2016-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1892757, encodeId=fd8d1892e5717, content=<a href='/topic/show?id=c738e93521f' target=_blank style='color:#2F92EE;'>#缺血性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79352, encryptionId=c738e93521f, topicName=缺血性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66ec123, createdName=guihongzh, createdTime=Sat Jun 25 10:52:00 CST 2016, time=2016-06-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1782910, encodeId=032b1e82910b4, content=<a href='/topic/show?id=c1fa456550' target=_blank style='color:#2F92EE;'>#CHA2#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4565, encryptionId=c1fa456550, topicName=CHA2)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ca89104, createdName=huperzia, createdTime=Mon Apr 24 08:52:00 CST 2017, time=2017-04-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1356075, encodeId=afc313560e5bc, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Thu Jun 02 07:52:00 CST 2016, time=2016-06-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562367, encodeId=15d4156236e72, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Thu Jun 02 07:52:00 CST 2016, time=2016-06-02, status=1, ipAttribution=)]
    2016-10-13 ylzr123

    拜读了,受益匪浅,点个赞!

    0

  5. 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  6. 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encodeId=032b1e82910b4, content=<a href='/topic/show?id=c1fa456550' target=_blank style='color:#2F92EE;'>#CHA2#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4565, encryptionId=c1fa456550, topicName=CHA2)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ca89104, createdName=huperzia, createdTime=Mon Apr 24 08:52:00 CST 2017, time=2017-04-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1356075, encodeId=afc313560e5bc, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Thu Jun 02 07:52:00 CST 2016, time=2016-06-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562367, encodeId=15d4156236e72, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Thu Jun 02 07:52:00 CST 2016, time=2016-06-02, status=1, ipAttribution=)]
    2016-08-09 quxin068
  7. 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time=2016-06-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562367, encodeId=15d4156236e72, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Thu Jun 02 07:52:00 CST 2016, time=2016-06-02, status=1, ipAttribution=)]
  8. 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encodeId=032b1e82910b4, content=<a href='/topic/show?id=c1fa456550' target=_blank style='color:#2F92EE;'>#CHA2#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4565, encryptionId=c1fa456550, topicName=CHA2)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ca89104, createdName=huperzia, createdTime=Mon Apr 24 08:52:00 CST 2017, time=2017-04-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1356075, encodeId=afc313560e5bc, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Thu Jun 02 07:52:00 CST 2016, time=2016-06-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562367, encodeId=15d4156236e72, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Thu Jun 02 07:52:00 CST 2016, time=2016-06-02, status=1, ipAttribution=)]
    2017-04-24 huperzia
  9. 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encodeId=032b1e82910b4, content=<a href='/topic/show?id=c1fa456550' target=_blank style='color:#2F92EE;'>#CHA2#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4565, encryptionId=c1fa456550, topicName=CHA2)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ca89104, createdName=huperzia, createdTime=Mon Apr 24 08:52:00 CST 2017, time=2017-04-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1356075, encodeId=afc313560e5bc, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Thu Jun 02 07:52:00 CST 2016, time=2016-06-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562367, encodeId=15d4156236e72, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Thu Jun 02 07:52:00 CST 2016, time=2016-06-02, status=1, ipAttribution=)]
    2016-06-02 zhaojie88
  10. 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time=2016-06-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562367, encodeId=15d4156236e72, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Thu Jun 02 07:52:00 CST 2016, time=2016-06-02, status=1, ipAttribution=)]
    2016-06-02 slcumt

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背景:CHA2DS2-VASc评分的目的是改善房颤患者的缺血性卒中风险分层,识别那些可以安全地放弃口服抗凝药的患者。口服抗凝治疗指南对CHA2DS2-VASC分值为1的治疗仍不确定。研究者进行了一项系统回顾和荟萃分析房颤患者,CHA2DS2-VASc评分为0,1或2分,未进行口服抗凝治疗,患者缺血性卒中风险。方法:研究者检索了从数据库开始日期到2015年4月15日,MEDLINE、EMBASE、P

PLoS One: SAMe-TT2R2评分预测中国房颤患者华法林治疗的控制情况

背景:华法林用于房颤患者(AF)卒中预防的安全性和有效性取决于治疗范围的时间(TTR)。研究者旨在评估SAMe-TT2R2分数对中国应用华法林的房颤患者的预测能力,其TTR是众所周知的差。方法:这是一个单中心回顾性研究。1997到2011间诊断为非瓣膜性房颤患者,根据SAMe-TT2R2分数将其进行分层,采用Rosendaal方法计算TTR。TTR> 70% ,SAMe-TT2R2分数的预测

Stroke:血管紧张素受体阻断剂和β-阻断剂与老年人卒中发生相关

背景:研究旨在确定65岁老年人,不同抗高血压药物及长期血压变异率(BPV)与卒中事件发生的相关性。在老年人≥65年。方法:样本包括5951名受试者(平均年龄74岁,60%名女性),受试者至少服用1种药物治疗高血压(3727/5951)或收缩压>140毫米汞柱或舒张压>90毫米汞柱。在随访的12年中,评估受试者致命性和非致命性卒中事件的发生。对9种类别的降压药,采用变异系数和回归计算BPV(BPVr

PLoS One:臭氧浓度升高与卒中发生增加相关

背景:日益升高的臭氧浓度已破坏人类健康和生态系统。尽管臭氧呈现昼夜变异,多数研究报告当天或后一天缺血性脑卒中的发生,仅白天臭氧浓度相关。研究者调查了臭氧的昼夜变化对缺血性卒中发生的影响。方法:研究者在韩国汉城的一家三级医院,招募2008年1月1日到2014年12月31日的1734例患者。研究者评估每个时间段和平均参数(7年的研究中获得),卒中发生时温度和污染物的差异。结果:相比于其他时间段,13:

Ann Neurol:阿尔茨海默症和小血管缺血性卒中存在共同的遗传易感性

目的:越来越多的证据表明,阿尔茨海默氏症(AD)和缺血性卒中(IS)之间的流行病学和病理学相关。研究者调查的证据表明,这两种疾病存在共同的遗传因素。方法:应用METASTROKE +((15916例IS病例和68826例对照)和IGAP(17008例AD患者和37154名对照)研究中的数据,进行全基因组关联研究(GWAS),研究者评估AD和IS的相关性。研究者可获得基因水平的数据(4610例IS患

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