Comparisons of CHADS₂ and CHA₂DS₂-VASc scores for stroke risk stratification in atrial fibrillation: Which scoring system should be used for Asians?

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• 作者：Tze-Fan Chao ; MD^* ; ^&dagger ; ; Chia-Jen Liu ; MD^&Dagger ; ; ^§ ; ; Ta-Chuan Tuan ; MD^* ; ^&dagger ; ; Su-Jung Chen ; MD^§ ; ; ^¶ ; ; Kang-Ling Wang ; MD^* ; ^&dagger ; ; Yenn-Jiang Lin ; MD^* ; ^&dagger ; ; Shih-Lin Chang ; MD^* ; ^&dagger ; ; ^{cechiang@vghtpe.gov.tw" class="auth_mail" title="E-mail the corresponding author} ; Li-Wei Lo ; MD^* ; ^&dagger ; ; Yu-Feng Hu ; MD^* ; ^&dagger ; ; Tzeng-Ji Chen ; MD^** ; Chern-En Chiang ; MD ; PhD^* ; ^&dagger ; ; ^&dagger ; &dagger ; ; ^&Dagger ; &Dagger ; ; ^{epsachen@ms41.hinet.net" class="auth_mail" title="E-mail the corresponding author} ; Shih-Ann Chen ; MD^* ; ^&dagger ;
• 关键词：AF ; atrial fibrillation ; APHRS ; Asia Pacific Heart Rhythm Society ; CI ; confidence interval ; ICD-9-CM ; International Classification of Diseases ; Ninth Revision ; Clinical Modification ; NHI ; National Health Insurance ; NHIRD ; National Health Insurance Research Database ; NHRI ; National Health Research Institutes ; NOAC ; non&ndash ; vitamin K antagonist oral anticoagulant ; OAC ; oral anticoagulant ; ROC ; receiver operating characteristic ; TIA ; transient ischemic attack
• 刊名：Heart Rhythm
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：13
• 期：1
• 页码：46-53
• 全文大小：1330 K

文摘

Both U.S. and European guidelines recommend use of the CHA₂DS₂-VASc rather than CHADS₂ score for stroke risk stratification in atrial fibrillation (AF). However, the CHA₂DS₂-VASc score has not been proved to be better than CHADS₂ score for Asians in a large-scale study.

Objective

The purpose of this study was to compare the accuracies of CHADS₂ and CHA₂DS₂-VASc scores in predicting ischemic stroke in Chinese patients.

Methods

This study used the National Health Insurance Research Database in Taiwan. A total of 186,570 AF patients without antithrombotic therapies were selected as the study cohort. The clinical end-point was occurrence of ischemic stroke.

Results

During follow-up of 3.4 ± 3.7 years, 23,723 patients (12.7%) experienced ischemic stroke. The CHA₂DS₂-VASc score performed better than CHADS₂ score in predicting ischemic stroke assessed by c-indexes (0.698 vs 0.659, P <.0001). Among 25,286 patients with a CHADS₂ score of 0, the CHA₂DS₂-VASc score ranged from 0 to 3, and the annual stroke rate ranged from 1.15% to 4.47%. Compared to patients with a CHA₂DS₂-VASc score of 0, the hazard ratio of ischemic stroke for patients with a CHA₂DS₂-VASc score of 3 was 3.998.

Conclusion

Patients with a CHADS₂ score of 0 were not necessarily “low risk,” and the annual stroke rate can be as high as 4.47% when patients were further stratified by the CHA₂DS₂-VASc score. In contrast, patients with a CHA₂DS₂-VASc score of 0 had a truly low risk of ischemic stroke, with an annual stroke rate around 1.15%. As with Caucasians, the CHA₂DS₂-VASc score should be used for stroke risk stratification in Asians.