Stroke risk stratifications according to CHA2DS2-VASc vs. CHA2DS2-VA in patients with atrial fibrillation: insights from the GLORIA-AF registry.

IF 6.1 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

European Heart Journal - Cardiovascular Pharmacotherapy Pub Date : 2025-08-12 DOI:10.1093/ehjcvp/pvaf031

Steven Ho Man Lam, Giulio Francesco Romiti, Bernadette Corica, Tommaso Bucci, Brian Olshansky, Tze-Fan Chao, Menno V Huisman, Gregory Y H Lip

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引用次数: 0

Abstract

Aims: Whether the adoption of CHA2DS2-VA score, the sex-independent version of the CHA2DS2-VASc score is beneficial for stratifying risk of stroke in patients with atrial fibrillation (AF) remains controversial.

Methods and results: Utilizing the data from the global, multicentre and prospective GLORIA-AF Registry Phase III, we compared the performances of CHA2DS2-VA and CHA2DS2-VASc scores in stratifying the risk of ischaemic stroke and thromboembolism (TE), and compared the risk of ischaemic stroke and TE, and the use of oral anticoagulants in male and female patients with AF. A total of 21 260 AF patients with available data were included in the analysis (mean age 70.2 ± 10.3 years, 44.9% female). Overall, female patients were less likely prescribed with oral anticoagulant (OAC) compared with males [odds ratio: 0.90, 95%confidence interval [CI]: (0.83-0.97)]. A significant interaction (P < 0.001) between sex and age was observed, with a lower likelihood of receiving OAC among younger female patients.The risk of ischaemic stroke [hazard ratio (HR):1.14, 95%CI: (0.85-1.53)] and TE [HR: 1.02, 95%CI: (0.82-1.26)] was similar between male and female patients, and the predictive ability of the two scores was similar for both outcomes: TE [area under the receiver operating characteristic curve (AUC): 0.641, 95%CI: (0.585-0.697) vs. AUC: 0.636, 95%CI: (0.580-0.692); P = 0.593] and ischaemic stroke [AUC: 0.660, (95%CI: 0.582-0.739) vs. AUC: 0.646, (95%CI: 0.568-0.725); P = 0.847]. There was a possible interaction between sex and age observed, with a higher risk of TE in younger female patients (P = 0.051).

Conclusion: CHA2DS2-VA score had similar predictive performance for thromboembolic events compared with CHA2DS2-VASc score. The role of female sex in the management and outcomes of patients with AF may differ according to age. Whether the omission of the female criterion from CHA2DS2-VA would lead to less OAC use in female AF patients over the next years remains to be seen.

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房颤患者CHA2DS2-VASc与CHA2DS2-VA的卒中风险分层：来自GLORIA-AF登记的见解

背景：采用CHA2DS2-VA评分、性别无关的CHA2DS2-VASc评分是否有利于心房颤动（AF）患者卒中风险分层仍存在争议。方法：利用全球、多中心和前瞻性的GLORIA-AF登记III期数据，我们比较CHA2DS2-VA和CHA2DS2-VASc评分在缺血性卒中和血栓栓塞（TE）风险分层中的表现，并比较缺血性卒中和TE的风险，以及男性和女性AF患者口服抗凝剂的使用。结果：共有21260例房颤患者纳入分析（平均年龄70.2±10.3岁，女性44.9%）。总体而言，与男性患者相比，女性患者较少使用OAC （OR:0.90, 95%CI:[0.83-0.97]）。结论：CHA2DS2-VA评分与CHA2DS2-VASc评分相比，对血栓栓塞事件的预测效果相似。女性在房颤患者的治疗和预后中的作用可能因年龄而异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Heart Journal - Cardiovascular Pharmacotherapy Medicine-Cardiology and Cardiovascular Medicine

CiteScore

10.10

自引率

14.10%

发文量

期刊介绍： The European Heart Journal - Cardiovascular Pharmacotherapy (EHJ-CVP) is an international, peer-reviewed journal published in English, specifically dedicated to clinical cardiovascular pharmacology. EHJ-CVP publishes original articles focusing on clinical research involving both new and established drugs and methods, along with meta-analyses and topical reviews. The journal's primary aim is to enhance the pharmacological treatment of patients with cardiovascular disease by interpreting and integrating new scientific developments in this field. While the emphasis is on clinical topics, EHJ-CVP also considers basic research articles from fields such as physiology and molecular biology that contribute to the understanding of cardiovascular drug therapy. These may include articles related to new drug development and evaluation, the physiological and pharmacological basis of drug action, metabolism, drug interactions, and side effects.