比较CHADS2和CHA2DS2-VASc评分对非瓣膜性心房颤动卒中和血栓栓塞发生风险的预测价值——Meta分析

被引：4

作者：

朱文根 ^{[1
]}

熊琴梅 ^{[1
]}

洪葵 ^{[1
,2
]}

机构：

[1] 南昌大学第二附属医院心内科

[2] 江西省分子医学重点实验室

来源：

临床心血管病杂志 | 2015年 / 31卷 / 06期

关键词：

心房颤动; CHADS2; CHA2DS2-VASc; 卒中; 血栓栓塞;

D O I：

10.13201/j.issn.1001-1439.2015.06.017

中图分类号：

R541.75 [];

学科分类号：

摘要：

目的:比较CHADS2和CHA2DS2-VASc评分对非瓣膜性心房颤动(NVAF)患者卒中和血栓栓塞发生风险的预测价值。方法:系统性检索Cochrane图书馆,EMBASE、EBSCO和PubMed数据库中有关CHADS2和CHA2DS2-VASc评分预测NVAF患者卒中和血栓栓塞发生风险的英文文献。采用STATA 12.0软件进行统计分析。结果:本研究共纳入11篇文献。当C-统计量作为连续型变量分析时,CHADS2评分C-统计量分布从0.650到0.717,中位数0.660;CHA2DS2-VASc评分C-统计量分布从0.637到0.724,中位数0.697,合并后C-统计量分别为0.66(0.66～0.67)和0.67(0.66～0.68)。当C-统计量作为分类型变量分析时,CHADS2评分C-统计量分布从0.586到0.722,中位数0.630;CHA2DS2-VASc评分C-统计量分布从0.521到0.850,中位数0.606,合并后C-统计量分别为0.65(0.62～0.67)和0.63(0.59～0.68),但存在高异质性,结果需慎重分析。CHA2DS2-VASc评分低危组的不良事件发生率明显比CHADS2评分低(0.54%:1.40%,P<0.05),且将更多的患者划分到高危组(81.0%:46.0%,P<0.05)。结论:CHADS2和CHA2DS2-VASc评分对NVAF患者卒中和血栓栓塞发生风险的预测价值相类似。但CHA2DS2-VASc评分更容易发现真正"低危"患者,且将更多的患者纳入高危组,有利于指导临床上预防性治疗。

引用

页码：644 / 648

页数：5

共 21 条

[1] Should We Recommend Oral Anticoagulation Therapy in Patients With Atrial Fibrillation Undergoing Coronary Artery Stenting With a High HAS-BLED Bleeding Risk Score? [J].

Ruiz-Nodar, Juan M. ;

Marin, Francisco ;

Roldan, Vanessa ;

Valencia, Jose ;

Manzano-Fernandez, Sergio ;

Caballero, Luis ;

Hurtado, Jose A. ;

Sogorb, Francisco ;

Valdes, Mariano ;

Lip, Gregory Y. H. .

CIRCULATION-CARDIOVASCULAR INTERVENTIONS, 2012, 5 (04) :459-466

[2]

Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Lip Gregory Y H,Nieuwlaat Robby,Pisters Ron,Lane Deirdre A,Crijns Harry J G M. Chest . 2009

[3]

Does CHA2DS2-VASc improve stroke risk stratification in postmenopausal women with atrial fibrillation?. ABRAHAM J M,LARSON J,CHUNG M K,et al. The American Journal of Medicine . 2013

[4]

Users’ guides to the medical literature: XXII: how to use articles about clinical decision rules. Evidence-Based Medicine Working Group. McGinn T G,Guyatt G H,Wyer P C,Naylor C D,Stiell I G,Richardson W S. JAMA : the journal of the American Medical Association . 2000

[5]

Validation of risk stratification schemes for predicting stroke and thromboembolism in patients with atrial fibrillation: nationwide cohort study. Jonas Bjerring Olesen,Gregory Y H Lip,Morten Lock Hansen,Peter Riis Hansen,Janne Schurmann Tolstrup,Jesper Lindhardsen,Christian Selmer,Ole Ahlehoff,Anne-Marie Schjerning Olsen,Gunnar Hilmar Gislason,Christian Torp-Peders. British Medical Journal . 2011

[6]

Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. Gage B F,Waterman A D,Shannon W,Boechler M,Rich M W,Radford M J. JAMA : the journal of the American Medical Association . 2001

[7]

Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Hart Robert G,Pearce Lesly A,Aguilar Maria I. Annals of Internal Medicine . 2007

[8]

2012 focused update of the ESC Guidelines for the management of atrial fibrillation An update of the 2010 ESC Guidelines for the management of atrial fibrillation Developed with the special contribution of the European Heart Rhythm Association. A. John Camm,Gregory Y. H. Lip,Raffaele De Caterina. Europace . 2012

[9]

Comparison of clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation. Aakre CA,McLeod CJ,Cha SS, et al. Stroke . 2014

[10]

CHADS2 versus CHA2DS2-VASc score in assessing the stroke and thromboembolism risk stratification in patients with atrial fibrillation:a systematic review and meta-analysis. Chen JY,Zhang AD,Lu HY,et al. J Geriatr Cardiol . 2013

← 1 2 3 →