Chronic Kidney Disease and CHADS₂ Score Independently Predict Cardiovascular Events and Mortality in Patients With Nonvalvular Atrial Fibrillation

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• 作者：Keiko Nakagawa MD^a ; Tadakazu Hirai MD^a ; ^{thirai@med.u-toyama.ac.jp} ; Shutaro Takashima MD^b ; Nobuyuki Fukuda MD^a ; Kazumasa Ohara MD^a ; Etsuko Sasahara MD^b ; Yoshiharu Taguchi MD^b ; Nobuhiro Dougu MD^b ; Takashi Nozawa MD^a ; Kortaro Tanaka MD^b ; Hiroshi Inoue MD^a
• 刊名：The American Journal of Cardiology
• 出版年：2011
• 出版时间：15 March 2011
• 年：2011
• 卷：107
• 期：6
• 页码：912-916
• 全文大小：281 K

文摘

Chronic kidney disease is a risk factor for cardiovascular events, but how it relates to the prognosis associated with clinical risk factors for thromboembolism in patients with nonvalvular atrial fibrillation (AF) is not well known. Estimated glomerular filtration rate (eGFR), score for congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, and stroke/transient ischemic attack (CHADS₂), and clinical outcomes of cardiovascular events were determined in 387 patients with nonvalvular AF (mean age 66 years, 289 men, mean follow-up 5.6 ± 3.2 years). Decreased eGFR (<60 ml/min/1.73 m²) combined with CHADS₂ score ≥2 was associated with higher all-cause (12.9 % vs 1.4 % per year, hazard ratio [HR] 6.9, p <0.001) and cardiovascular (6.5 % vs 0.2 % per year, HR 29.7, p <0.001) mortalities compared to preserved eGFR (≥60 ml/min/1.73 m²) combined with CHADS₂ score <2. This was also true for rates of cardiac events (cardiac death, nonfatal myocardial infarction, or hospitalization for worsening of heart failure, 10.4 % vs 1.3 % per year, HR 8.9, p <0.001), ischemic stroke (3.6 % vs 0.2 % per year, HR 11.0, p <0.001), and cardiovascular events (cardiac events and ischemic stroke, 13.6 % vs 1.5 % per year, HR 8.3, p <0.001). On multivariate analysis, CHADS₂ score ≥2, decreased eGFR, and male gender independently predicted all-cause mortality. In conclusion, combined eGFR and CHADS₂ score could be an independent powerful predictor of cardiovascular events and mortality in patients with nonvalvular AF. Long-term mortality, cardiac events, and stroke risk were >8 times higher when decreased eGFR (<60 ml/min/1.73 m²) was present with higher CHADS₂ score (≥2).