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改进CHA2DS2VASc风险分层方案:我们是否应该放弃性别类别标准?

Hiroyuki Yoshimura¹, Rui Providencia^1,2, Chris Finan³

¹Institute of Health Informatics Research, University College London, 222 Euston Road, London NW1 2DA, UK.

Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology

|November 10, 2024

概括

从CHA2DS2VASc得分 (CHA2DS2VA) 中删除性别类别可以保持心房动 (AF) 患者中风风险预测的准确性. 这种简化得分有助于对血栓预防的决策.

科学领域:

心脏病学心脏病学
血栓形成研究研究
临床风险分层的临床风险分层

背景情况:

CHA2DS2VASc评分是对心房动 (AF) 中中风风险分层的标准.
该得分包括女性性别的一分,基于较旧的数据表明血栓栓塞风险更高.
最近的数据表明,这种基于性别的风险差异已经显著减少.

研究的目的:

为了评估经过修改的CHA2DS2VASc得分的表现,不包括性别类别 (CHA2DS2VA).
为了确定是否删除性别标准会影响得分在预测血栓栓塞事件的准确性.
评估CHA2DS2VA得分在指导抗凝血决策方面的临床有用性.

主要方法:

英国初级和二级护理数据的分析 (195,719名AF患者,1998-2016).
在非抗凝血患者中,每年比较CHA2DS2VASc和CHA2DS2VA得分.
在413,007个患者年内评估中风和全身栓塞事件 (总共8,742) .

主要成果:

CHA2DS2VA得分显示出与CHA2DS2VASc.c.相似的区分能力 (C统计数据为0.62-0.71).
血栓栓塞栓风险的性别差异在较低风险组没有显著,但在较高风险组持续存在 (CHA2DS2VA ≥2).
净重新分类改进显示,CHA2DS2VA较低风险组的分类更好,高风险组的错误分类最小.

结论:

从CHA2DS2VASc得分中排除性别类别不会影响其预测AF患者血栓栓塞事件的能力.
CHA2DS2VA评分为初始风险评估提供了一种简化方法.
这种简化得分可以简化启动血栓预防的决策过程.

关键词:

心房动是一种心房动.电子健康记录电子健康记录血栓栓塞瘤风险预测预测血栓栓塞瘤风险分层分数的分数

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