通过结合多原风险得分和临床特征来预测中风后心房动
Reinier W P Tack1,2,3, Benjamin Y Q Tan1,2,3,4, Jasper R Senff1,2,3
1McCance Center for Brain Health (R.W.P.T., B.Y.Q.T., J.R.S., S.P., T.N.K., S.D.S., J.R., E.M., C.D.A.), Massachusetts General Hospital, Boston.
Stroke
|January 30, 2025
概括
在中风后识别心房动 (AF) 对于预防复发性中风至关重要. 多基因风险评分 (PRS) 可以改善中风幸存者的AF预测,特别是在中风后的第一个月内.
科学领域:
- 心脏病学 心脏病学
- 遗传学 遗传学是一种遗传学.
- 脑卒中医学 脑卒中医学
背景情况:
- 在中风后识别患有发生性心房风险的患者对于通过抗凝剂治疗预防复发性中风至关重要.
- 在中风后对AF的现有临床风险预测指标的准确性有限.
研究的目的:
- 调查是否将AF多基因风险评分 (PRS) 纳入现有的临床风险预测指标中,可以提高中风后AF的预测.
- 评估AF PRS在识别患有AF风险高的中风幸存者的增值值.
主要方法:
- 分析了2003年至2017年间诊断的缺血性中风患者队列.
- 临床AF风险使用CHAARTED AF模型进行评估,遗传风险使用来自100多万种变异的当代AF PRS进行评估.
- 考克斯的比例危险模型和重新分类指标 (C指数,NRI) 用于评估使用或不使用AF PRS的模型性能.
主要成果:
- 在1004名中风幸存者中,有23.8%的人患有流行性AF,11.4%的人在5年内发展出事件性AF.
- AF PRS显示出发生性AF风险增加的趋势 (HR 1.21每SD增加),尽管在统计学上并不显著.
- 在中风后的第一个月,添加AF PRS显著改善了AF预测歧视 (AUC为0.78对0.71,P=0.05).
结论:
- 将AF多基因风险评分整合到临床风险模型中,有望改善在中风后面临AF风险的个体的识别.
- AF PRS的预测益处在中风后的早期最为明显,特别是在第一个月内.
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