CHA2DS2-VASc评分在预测急性支架内血栓形成中的价值
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摘要
目的评估CHA2DS2-VASc评分在接受经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗的非心房颤动(房颤)患者中,对急性支架内血栓形成的预测价值。方法 2015年1月至2015年12月,武汉亚洲心脏病医院共有27例患者诊断为急性支架内血栓形成,纳入急性支架内血栓(+)组。4 741例接受PCI治疗的患者纳入急性支架内血栓(-)组。所有患者术前计算CHA2DS2-VASc评分。分析两组患者基线临床特征,不同分值的急性支架内血栓发病率。多元回归分析急性支架内血栓形成的独立危险因素。结果急性支架内血栓(+)组的CHA2DS2-VASc评分高于急性支架内血栓(-)组,差异有统计学意义[(3.74±1.68)分vs.评分为(2.08±1.17)分,P<0.001]。随着CHA2DS2-VASc评分增加,急性支架内血栓发病率也增加。CHA2DS2-VASc评分>2分、急性冠状动脉综合征、糖尿病、原发性高血压、脑卒中病史是急性支架内血栓形成的独立危险因素。结论 CHA2DS2-VASc评分>2分是急性支架内血栓形成的独立危险因素。PCI治疗前的患者均可计算这一评分,对评分高的患者PCI治疗后应密切监测。
Objectives To evaluate the predictive value of CHA2DS2-VASc score in acute stent thrombosis in patients with atrial fibrillation(AF)-free patients after percutaneous coronary intervention(PCI). Methods There were 27 patients diagnosed as acute stent thrombosis from January 2015 to December 2015 in Wuhan Asia Heart Hospital who were included in acute stent thrombosis(+)group and 4 741 patients received stent implantation without acute stent thrombosis were included in acute stent thrombosis(-)group. CHA2DS2-VASc score was calculated in each patient before operation. Statistical analysis was undergone at baseline characteristics between each group and morbidity of acute stent thrombosis according by CHA2DS2-VASc score. A Logistic regression analysis was used to evaluate the independent risk of acute stent thrombosis. Results CHA2DS2-VASc score in acute stent thrombosis(+)group was significantly higher than that in acute stent thrombosis(-)group[(3.74±1.68)score vs.(2.08±1.17)score,P<0.001].Morbidity of acute stent thrombosis increased according by increasing CHA2DS2-VASc score. In Logistic regression analysis,CHA2DS2-VASc>2,acute coronary syndrome,diabetes,hypertension,history of stroke were found to be independent predictors of acute stent thrombosis. Conclusions CHA2DS2-VASc>2 is an independent predictor of acute stent thrombosis. CHA2DS2-VASc score should be calculated in each patient receiving PCI. Patients with a high CHA2DS2-VASc score should be closely monitored.
Objectives To evaluate the predictive value of CHA2DS2-VASc score in acute stent thrombosis in patients with atrial fibrillation(AF)-free patients after percutaneous coronary intervention(PCI). Methods There were 27 patients diagnosed as acute stent thrombosis from January 2015 to December 2015 in Wuhan Asia Heart Hospital who were included in acute stent thrombosis(+)group and 4 741 patients received stent implantation without acute stent thrombosis were included in acute stent thrombosis(-)group. CHA2DS2-VASc score was calculated in each patient before operation. Statistical analysis was undergone at baseline characteristics between each group and morbidity of acute stent thrombosis according by CHA2DS2-VASc score. A Logistic regression analysis was used to evaluate the independent risk of acute stent thrombosis. Results CHA2DS2-VASc score in acute stent thrombosis(+)group was significantly higher than that in acute stent thrombosis(-)group[(3.74±1.68)score vs.(2.08±1.17)score,P<0.001].Morbidity of acute stent thrombosis increased according by increasing CHA2DS2-VASc score. In Logistic regression analysis,CHA2DS2-VASc>2,acute coronary syndrome,diabetes,hypertension,history of stroke were found to be independent predictors of acute stent thrombosis. Conclusions CHA2DS2-VASc>2 is an independent predictor of acute stent thrombosis. CHA2DS2-VASc score should be calculated in each patient receiving PCI. Patients with a high CHA2DS2-VASc score should be closely monitored.
引文
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[7]DAEMEN J,WENAWESER P,TSUCHIDA K,et al.Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice:data from a large two-institutional cohort study[J].Lancet,2007,369(9562):667-678.
[8]PARK D W,PARK S W,PARK K H,et al.Frequency of and risk factors for stent thrombosis after drug-eluting stent implantation during long-term follow-up[J].Am J Cardiol,2006,98(3):352-356.
[9]ONG A T,HOYE A,AOKI J,et al.Thirty-day incidence and six-month clinical outcome of thrombotic stent occlusion after bare-metal,sirolimus,or paclitaxel stent implantation[J].JAm Coll Cardiol,2005,45(6):947-953.
[10]CRANDALL M A,HORNE B D,DAY J D,et al.Atrial fibrillation and CHADS2 risk factors are associated with highly sensitive C-reactive protein incrementally and independently[J].Pacing Clin Electrophysiol,2009,32(5):648-652.
[11]PUURUNEN M K,KIVINIEMI T,SCHLITT A,et al.CHADS2,CHA2DS2-VASc and HAS-BLED as predictors of outcome in patients with atrial fibrillation undergoing percutaneous coronary intervention[J].Thromb Res,2014,133(4):560-566.
[12]UEHARA M,FUNABASHI N,TAKAOKA H,et al.The CHADS2 score is a useful predictor of coronary arteriosclerosis on 320 slice CT and may correlate with prognosis in subjects with atrial fibrillation[J].Int J Cardiol,2015,179(1):84-89.
[13]ORVIN K,BENTAL T,ASSALI A,et al.Usefulness of the CHA2DS2-VASC Score to Predict Adverse Outcomes in Patients Having Percutaneous Coronary Intervention[J].Am J Cardiol,2016,117(9):1433-1438.
[2]PALMERINI T,DANGAS G,MEHRAN R,et al.Predictors and implications of stent thrombosis in non-ST-segment elevation acute coronary syndromes:the ACUITY Trial[J].Circ Cardiovasc Interv,2011,4(6):577-584.
[3]IAKOVOU I,SCHMIDT T,BONIZZONI E,et al.Incidence,predictors,and outcome of thrombosis after successful implantation of drug-eluting stents[J].JAMA,2005,293(17):2126-2130.
[4]MACHECOURT J,DANCHIN N,LABLANCHE J M,et al.Risk factors for stent thrombosis after implantation of sirolimuseluting stents in diabetic and nondiabetic patients:the EVAST-ENT Matched-Cohort Registry[J].J Am Coll Cardiol,2007,50(6):501-508.
[5]STONE G W,WITZENBICHLER B,WEISZ G,et al.Platelet reactivity and clinical outcomes after coronary artery implantation of drug-eluting stents(ADAPT-DES):a prospective multicentre registry study[J].Lancet,2013,382(9892):614-623.
[6]KUCHULAKANTI P K,CHU W W,TORGUSON R,et al.Correlates and long-term outcomes of angiographically proven stent thrombosis with sirolimus-and paclitaxel-eluting stents[J].Circulation,2006,113(8):1108-1113.
[7]DAEMEN J,WENAWESER P,TSUCHIDA K,et al.Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice:data from a large two-institutional cohort study[J].Lancet,2007,369(9562):667-678.
[8]PARK D W,PARK S W,PARK K H,et al.Frequency of and risk factors for stent thrombosis after drug-eluting stent implantation during long-term follow-up[J].Am J Cardiol,2006,98(3):352-356.
[9]ONG A T,HOYE A,AOKI J,et al.Thirty-day incidence and six-month clinical outcome of thrombotic stent occlusion after bare-metal,sirolimus,or paclitaxel stent implantation[J].JAm Coll Cardiol,2005,45(6):947-953.
[10]CRANDALL M A,HORNE B D,DAY J D,et al.Atrial fibrillation and CHADS2 risk factors are associated with highly sensitive C-reactive protein incrementally and independently[J].Pacing Clin Electrophysiol,2009,32(5):648-652.
[11]PUURUNEN M K,KIVINIEMI T,SCHLITT A,et al.CHADS2,CHA2DS2-VASc and HAS-BLED as predictors of outcome in patients with atrial fibrillation undergoing percutaneous coronary intervention[J].Thromb Res,2014,133(4):560-566.
[12]UEHARA M,FUNABASHI N,TAKAOKA H,et al.The CHADS2 score is a useful predictor of coronary arteriosclerosis on 320 slice CT and may correlate with prognosis in subjects with atrial fibrillation[J].Int J Cardiol,2015,179(1):84-89.
[13]ORVIN K,BENTAL T,ASSALI A,et al.Usefulness of the CHA2DS2-VASC Score to Predict Adverse Outcomes in Patients Having Percutaneous Coronary Intervention[J].Am J Cardiol,2016,117(9):1433-1438.
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