Rungroj Krittayaphong, Sirin Apiyasawat, Komsing Methavigul, Chulaluk Komoltri, Gregory Y H Lip
{"title":"亚洲人群CHA2DS2 -VA评分对缺血性卒中的预测：一份来自前瞻性全国COOL-AF登记的报告","authors":"Rungroj Krittayaphong, Sirin Apiyasawat, Komsing Methavigul, Chulaluk Komoltri, Gregory Y H Lip","doi":"10.1016/j.hrthm.2025.04.062","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The CHA<sub>2</sub>DS<sub>2</sub>-VA score, derived by the removal of women from the CHA<sub>2</sub>DS<sub>2</sub>-VASc score, has recently been recommended for the prediction of ischemic stroke/systemic embolism (SSE) in patients with atrial fibrillation (AF).</p><p><strong>Objective: </strong>Given the limited data in non-Western cohorts, the objective was to compare the performance of CHA<sub>2</sub>DS<sub>2</sub>-VASc and CHA<sub>2</sub>DS<sub>2</sub>-VA scores for the prediction of SSE in an Asian population.</p><p><strong>Methods: </strong>Patients with AF from the prospective multicenter Cohort of Antithrombotic Use and Optimal INR Level in Patients With Nonvalvular Atrial Fibrillation registry were studied. Patients were followed up every 6 months for 3 years. The primary outcome was SSE. C-statistics were used to compare the performance of CHA<sub>2</sub>DS<sub>2</sub>-VASc and CHA<sub>2</sub>DS<sub>2</sub>-VA scores for SSE risk prediction. The pattern of oral anticoagulant use is according to the practicing physicians.</p><p><strong>Results: </strong>A total of 3405 patients were studied (mean age 67.8 ± 11.3 years, 41.8% women). The incidence rate of SSE was 1.51 (1.26-1.78) per 100 person-years. The risk ratio for SSE for women was higher than men at CHA<sub>2</sub>DS<sub>2</sub>-VA scores ≥ 2 (1.72 [1.19-2.50], P = .004), similar for patients with and without oral anticoagulant use. The C-statistics for SSE was not statistically significantly different between CHA<sub>2</sub>DS<sub>2</sub>-VASc and CHA<sub>2</sub>DS<sub>2</sub>-VA scores (0.655 [0.639-0.671] and 0.647 [0.631-0.663], P = .258). Women had a greater risk of SSE than men at the age of > 70 years (P<sub>interaction</sub> = .007).</p><p><strong>Conclusion: </strong>Women with AF have an increased SSE risk compared with men with higher CHA<sub>2</sub>DS<sub>2</sub>-VA scores and at the age of > 70 years. The CHA<sub>2</sub>DS<sub>2</sub>-VA scores had a numerical but nonstatistically significant difference to CHA<sub>2</sub>DS<sub>2</sub>-VASc score for SSE risk prediction.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6000,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Prediction of ischemic stroke by the CHA<sub>2</sub>DS<sub>2</sub>-VA score in an Asian population: A report from the prospective nationwide COOL-AF registry.\",\"authors\":\"Rungroj Krittayaphong, Sirin Apiyasawat, Komsing Methavigul, Chulaluk Komoltri, Gregory Y H Lip\",\"doi\":\"10.1016/j.hrthm.2025.04.062\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The CHA<sub>2</sub>DS<sub>2</sub>-VA score, derived by the removal of women from the CHA<sub>2</sub>DS<sub>2</sub>-VASc score, has recently been recommended for the prediction of ischemic stroke/systemic embolism (SSE) in patients with atrial fibrillation (AF).</p><p><strong>Objective: </strong>Given the limited data in non-Western cohorts, the objective was to compare the performance of CHA<sub>2</sub>DS<sub>2</sub>-VASc and CHA<sub>2</sub>DS<sub>2</sub>-VA scores for the prediction of SSE in an Asian population.</p><p><strong>Methods: </strong>Patients with AF from the prospective multicenter Cohort of Antithrombotic Use and Optimal INR Level in Patients With Nonvalvular Atrial Fibrillation registry were studied. Patients were followed up every 6 months for 3 years. The primary outcome was SSE. C-statistics were used to compare the performance of CHA<sub>2</sub>DS<sub>2</sub>-VASc and CHA<sub>2</sub>DS<sub>2</sub>-VA scores for SSE risk prediction. The pattern of oral anticoagulant use is according to the practicing physicians.</p><p><strong>Results: </strong>A total of 3405 patients were studied (mean age 67.8 ± 11.3 years, 41.8% women). The incidence rate of SSE was 1.51 (1.26-1.78) per 100 person-years. The risk ratio for SSE for women was higher than men at CHA<sub>2</sub>DS<sub>2</sub>-VA scores ≥ 2 (1.72 [1.19-2.50], P = .004), similar for patients with and without oral anticoagulant use. The C-statistics for SSE was not statistically significantly different between CHA<sub>2</sub>DS<sub>2</sub>-VASc and CHA<sub>2</sub>DS<sub>2</sub>-VA scores (0.655 [0.639-0.671] and 0.647 [0.631-0.663], P = .258). Women had a greater risk of SSE than men at the age of > 70 years (P<sub>interaction</sub> = .007).</p><p><strong>Conclusion: </strong>Women with AF have an increased SSE risk compared with men with higher CHA<sub>2</sub>DS<sub>2</sub>-VA scores and at the age of > 70 years. The CHA<sub>2</sub>DS<sub>2</sub>-VA scores had a numerical but nonstatistically significant difference to CHA<sub>2</sub>DS<sub>2</sub>-VASc score for SSE risk prediction.</p>\",\"PeriodicalId\":12886,\"journal\":{\"name\":\"Heart rhythm\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":5.6000,\"publicationDate\":\"2025-05-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Heart rhythm\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.hrthm.2025.04.062\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Heart rhythm","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.hrthm.2025.04.062","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Prediction of ischemic stroke by the CHA2DS2-VA score in an Asian population: A report from the prospective nationwide COOL-AF registry.
Background: The CHA2DS2-VA score, derived by the removal of women from the CHA2DS2-VASc score, has recently been recommended for the prediction of ischemic stroke/systemic embolism (SSE) in patients with atrial fibrillation (AF).
Objective: Given the limited data in non-Western cohorts, the objective was to compare the performance of CHA2DS2-VASc and CHA2DS2-VA scores for the prediction of SSE in an Asian population.
Methods: Patients with AF from the prospective multicenter Cohort of Antithrombotic Use and Optimal INR Level in Patients With Nonvalvular Atrial Fibrillation registry were studied. Patients were followed up every 6 months for 3 years. The primary outcome was SSE. C-statistics were used to compare the performance of CHA2DS2-VASc and CHA2DS2-VA scores for SSE risk prediction. The pattern of oral anticoagulant use is according to the practicing physicians.
Results: A total of 3405 patients were studied (mean age 67.8 ± 11.3 years, 41.8% women). The incidence rate of SSE was 1.51 (1.26-1.78) per 100 person-years. The risk ratio for SSE for women was higher than men at CHA2DS2-VA scores ≥ 2 (1.72 [1.19-2.50], P = .004), similar for patients with and without oral anticoagulant use. The C-statistics for SSE was not statistically significantly different between CHA2DS2-VASc and CHA2DS2-VA scores (0.655 [0.639-0.671] and 0.647 [0.631-0.663], P = .258). Women had a greater risk of SSE than men at the age of > 70 years (Pinteraction = .007).
Conclusion: Women with AF have an increased SSE risk compared with men with higher CHA2DS2-VA scores and at the age of > 70 years. The CHA2DS2-VA scores had a numerical but nonstatistically significant difference to CHA2DS2-VASc score for SSE risk prediction.
期刊介绍：
HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability.
HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community.
The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.
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