Age Threshold for Increased Stroke Risk Among Patients With Atrial Fibrillation A Nationwide Cohort Study From Taiwan

被引：104

作者：

Chao, Tze-Fan ^{[1
,2
,3
]}

Wang, Kang-Ling ^{[1
,2
,3
,4
,5
]}

Liu, Chia-Jen ^{[6
,7
,8
]}

Lin, Yenn-Jiang ^{[1
,2
,3
]}

Chang, Shih-Lin ^{[1
,2
,3
]}

Lo, Li-Wei ^{[1
,2
,3
]}

Hu, Yu-Feng ^{[1
,2
,3
]}

Tuan, Ta-Chuan ^{[1
,2
,3
]}

Chung, Fa-Po ^{[1
,2
,3
]}

Liao, Jo-Nan ^{[1
,2
,3
]}

Chen, Tzeng-Ji ^{[9
]}

Chiang, Chern-En ^{[1
,2
,3
,4
,5
]}

Lip, Gregory Y. H. ^{[10
]}

Chen, Shih-Ann ^{[1
,2
,3
]}

机构：

[1] Taipei Vet Gen Hosp, Dept Med, Div Cardiol, Taipei, Taiwan

[2] Natl Yang Ming Univ, Inst Clin Med, Taipei 112, Taiwan

[3] Natl Yang Ming Univ, Cardiovasc Res Ctr, Taipei 112, Taiwan

[4] Taipei Vet Gen Hosp, Gen Clin Res Ctr, Taipei, Taiwan

[5] Taipei Vet Gen Hosp, Dept Med Res & Educ, Taipei, Taiwan

[6] Taipei Vet Gen Hosp, Dept Med, Div Hematol & Oncol, Taipei, Taiwan

[7] Natl Yang Ming Univ, Inst Publ Hlth, Taipei 112, Taiwan

[8] Natl Yang Ming Univ, Sch Med, Taipei 112, Taiwan

[9] Taipei Vet Gen Hosp, Dept Family Med, Taipei, Taiwan

[10] Univ Birmingham, City Hosp, Ctr Cardiovasc Sci, Birmingham, W Midlands, England

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2015年 / 66卷 / 12期

关键词：

CHA(2)DS(2)-VASc score; ischemic stroke; risk assessment; Taiwan; CHA(2)DS(2)-VASC SCORE; ISCHEMIC-STROKE; STRATIFICATION SCHEMES; PREDICTING STROKE; ASIAN PATIENTS; WARFARIN; PREVENTION; CHADS(2); THROMBOEMBOLISM; IDENTIFICATION;

D O I：

10.1016/j.jacc.2015.07.026

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND Recent studies from Asia have suggested that the risk of ischemic stroke for patients with atrial fibrillation (AF) with a "low-risk" congestive heart failure, hypertension, age >= 75, diabetes mellitus, prior stroke or transient ischemic attack, vascular disease, age 65 to 74, female (CHA(2)DS(2)-VASc) score of 0 (for males) or 1 (for females) might be higher than that for non-Asians. OBJECTIVES This study hypothesized that the age threshold (65 years) used in the CHA(2)DS(2)-VASc system for initiating oral anticoagulants (OACs) might be lower in Taiwanese AF patients than in non-Asians. METHODS We used the National Health Insurance Research Database in Taiwan to study 186,570 nonanticoagulated AF patients. There were 9,416 males with a CHA(2)DS(2)-VASc score of 0 and 6,390 females with a CHA(2)DS(2)-VASc score of 1. Their risk of ischemic stroke was analyzed with stratification on the basis of age. RESULTS The annual risks of ischemic stroke for males (score 0) and females (score 1) were 1.15% and 1.12%, respectively, and continuously increased from younger to older age groups, with an increment in stroke risk evident for patients >50 years of age. At a cutoff of 50 years, patients could be further stratified into 2 subgroups with different stroke risks (>50 years of age: 1.78%/year; vs. <50 years of age: 0.53%/year). This observation was consistent for males (1.95%/year vs. 0.46%/year, respectively) and females (1.58%/year vs. 0.64%/year, respectively) with AF. In a subgroup analysis, the annual risks of ischemic stroke for males and females with AF 50 to 54 years of age were 1.47% and 1.07%, respectively. CONCLUSIONS For Taiwanese patients 50 to 64 years of age, the annual stroke risk was 1.78%, which may exceed the threshold for OAC use for stroke prevention. The annual risk of ischemic stroke for AF patients <50 years of age was 0.53%, which was truly low-risk, and OACs could be omitted. Whether resetting the age threshold to 50 years could refine current clinical risk stratification for Asian AF patients deserves further study. (C) 2015 by the American College of Cardiology Foundation.

引用

页码：1339 / 1347

页数：9

共 38 条

[31] Reliable Identification of "Truly Low" Thromboembolic Risk in Patients Initially Diagnosed With "Lone" Atrial Fibrillation The Belgrade Atrial Fibrillation Study [J].