• 作者：Eva Jover^a ; Vanessa Roldá ; n^b ; Pilar Gallego^b ; Diana Herná ; ndez-Romero^a ; Mariano Vald&#233 ; s^a ; Vicente Vicente^b ; Gregory Y.H. Lip^c ; Francisco Marí ; n^a ; ^{fcomarino@hotmail.com}
• 关键词：ACO ; anticoagulació ; n oral ; EAM ; eventos adversos mayores ; FA ; fibrilació ; n auricular ; INR ; razó ; n internacional normalizada
• 刊名：Revista Espa?ola de Cardiolog篓陋a
• 出版年：2012
• 期刊代码：pca308_03008932
• 类别：med
• 出版时间：July, 2012
• 卷：65
• 期：7
• 页码：627-633
• 文件大小：267 K

Introduction and objectives

The risk of stroke in atrial fibrillation is heterogeneous and depends upon underlying clinical conditions included in current risk stratification schemes. Recently, the CHA₂DS₂-VASc score has been included in guidelines to be more inclusive of common stroke risk factors seen in everyday clinical practice, and useful in defining 鈥渢ruly low risk鈥?subjects. We aimed to assess the usefulness of CHA₂DS₂-VASc score to give us an additional prognostic perspective for adverse events and mortality among 鈥渞eal world鈥?anticoagulated patients with atrial fibrillation who are often elderly with many comorbidities.

Methods

Consecutive outpatients with permanent/paroxysmal nonvalvular atrial fibrillation with CHA₂DS₂-VASc鈮? and stabilized oral anticoagulation (international normalized ratio 2.0-3.0) for at least the preceding 6 months were recruited. Patients with CHA₂DS₂-VASc鈮? were selected. Adverse cardiovascular events including stroke, acute coronary syndrome, or heart failure; major bleeds; and mortality were recorded during more than 2.5-year-follow-up.

Results

Of 933 patients (93.5%) assessed, 432 were males, median age 76 (71-81) years. After a follow-up of 946 (782-1068) days, 109 patients (11.7%) had adverse cardiovascular events, 80 patients (8.6%) had major bleeds, 101 patients (10.8%) died, and 230 (24.6%) had major adverse events (composite end-point). Increasing CHA₂DS₂-VASc score by 1 point had a significant impact on the occurrence of cardiovascular events (hazard ratio=1.27; 95%confidence interval, 1.13-1.44; m>Pm><.001), mortality (hazard ratio=1.36; 95%confidence interval, 1.19-1.54; m>Pm><.001); and major adverse events (hazard ratio=1.23; 95%confidence interval, 1.13-1.34; m>Pm><.001). CHA₂DS₂-VASc score was not associated with major bleeding episodes.

Conclusions

Among high risk atrial fibrillation patients on oral anticoagulation, CHA₂DS₂-VASc successfully predicts cardiovascular events and mortality, but not major bleeds.

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