• Int. J. Cardiol. · Sep 2013

    Validation of contemporary stroke and bleeding risk stratification scores in non-anticoagulated Chinese patients with atrial fibrillation.

    • Yutao Guo, Stavros Apostolakis, Andrew D Blann, Haijun Wang, Xiaoning Zhao, Yu Zhang, Dexian Zhang, Jingling Ma, Yutang Wang, and Gregory Y H Lip.
    • Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China; Haemostasis, Thrombosis and Vascular Biology Unit, University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom.
    • Int. J. Cardiol. 2013 Sep 30;168(2):904-9.

    BackgroundRisk stratification schemes assessing stroke and thromboembolism (stroke/TE) and bleeding relating to atrial fibrillation (AF) have largely been derived and validated in Western populations. We assessed risk factors that constitute scores for assessing stroke/TE (CHADS2, CHA2DS2-VASc) and bleeding (HAS-BLED), and the predictive value of these scores in a large cohort of Chinese patients with AF.Methods And ResultsWe studied 1034 AF patients (27.1% female, median age 75; 85.6% non-anticoagulated) with mean follow-up of 1.9 years. On multivariate analysis, vascular disease was independently associated with stroke/TE in non-anticoagulated patients (p=0.04). In patients with a CHADS2 or CHA2DS2-VASc score=1, the rate of stroke/TE was 2.9% and 0.9% respectively, but in patients at "high risk" (scores ≥ 2), this rate was 4.6% and 4.5%, respectively. The c-statistics for predicting stroke/TE with CHADS2 and CHA2DS2-VASc were 0.58 (p=0.109) and 0.72 (p<0.001), respectively. Compared to CHADS2, the use of CHA2DS2-VASc would result in a Net Reclassification Improvement (NRI) of 16.6% (p=0.009) and an Integrated Discrimination Improvement (IDI) of 1.1% (p=0.002). Cumulative survival of the patients with a CHA2DS2-VASc score≥2 was decreased compared to those with a CHA2DS2-VASc score 0-1 (p<0.001), but the CHADS2 was not predictive of mortality. There was an increased risk of major bleeding with increasing HAS-BLED score (c-statistic 0.61, 95% CI: 0.51-0.71, p=0.042).ConclusionsVascular disease was a strong independent predictor of stroke/TE in Chinese patients with AF. The CHA2DS2-VASc score performed better than CHADS2 in predicting stroke/TE in this Chinese AF population. Cumulative survival of the patients at high risk with the CHA2DS2-VASc score (but not using CHADS2) was significantly decreased.Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…