<br>使用 C2HEST 评分识别持续心房高频率发作的高危患者：西伯明翰心房颤动项目,Journal of the American Heart Association

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使用 C2HEST 评分识别持续心房高频率发作的高危患者：西伯明翰心房颤动项目
Journal of the American Heart Association ( IF 5.0 ) Pub Date : 2021-03-05 , DOI: 10.1161/jaha.120.017519
Yan-Guang Li _{1,

2} , Daniele Pastori ₃ , Kazuo Miyazawa ₁ , Farhan Shahid ₁ , Gregory Y H Lip _{1,

4}

Affiliation

背景佩戴心脏植入式电子设备的个体持续性心房高频率发作 (SAHRE) 与不良后果风险增加相关。 SAHRE 发展的风险分层从未被研究过。我们的目的是评估C ₂ HEST的表现（冠状动脉疾病或慢性阻塞性肺疾病[各1分]、高血压[1分]、老年人[年龄≥75岁，2分]、收缩性心力衰竭[2分] 、甲状腺疾病[1分]）评分在预测无心房颤动的心脏植入电子设备患者的SAHRE中的作用。方法和结果英国西伯明翰心房颤动项目中连续500名心脏植入电子设备患者自手术以来进行随访观察 SAHRE 的发展，SAHRE 的定义是持续 >24 小时的心房高频率发作。分析了 SAHRE 的危险因素和发生率。评估了C ₂ HEST评分对于SAHRE预测的预测价值。在平均 53.1 个月的随访中，44 名 (8.8%) 患者出现 SAHRE。 SAHRE 与较高的全因死亡率 ( P <0.001) 和缺血性卒中 ( P =0.001) 相关。年龄和心力衰竭与 SAHRE 的发生相关。 SAHRE 的发生率随 C ₂ HEST 评分的增加而增加（每增加一点，风险增加 39%）。在 C ₂ HEST 评分≥4 的患者中，每年 SAHRE 的发生率为 3.62%（95% CI，2.14-5.16）。 C ₂ HEST 评分具有中等预测能力（曲线下面积，0.73；95% CI，0.64-0.81）和判别能力（对数秩P = 0.003），优于其他临床评分（CHA ₂ DS ₂ ‐VASc、CHADS ₂ 、HATCH）。结论 C ₂ HEST 评分可预测植入心脏植入电子设备的无房颤患者的 SAHRE 发生率，风险最高C ₂ HEST 评分≥4 的患者在该患者群体的临床实践中使用 C ₂ HEST 评分的益处需要进一步研究。

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Identifying At‐Risk Patients for Sustained Atrial High‐Rate Episodes Using the C2HEST Score: The West Birmingham Atrial Fibrillation Project

BackgroundSustained atrial high‐rate episodes (SAHREs) among individuals with a cardiac implantable electronic device are associated with an increased risk of adverse outcomes. Risk stratification for the development of SAHREs has never been investigated. We aimed to assess the performance of the C₂HEST (coronary artery disease or chronic obstructive pulmonary disease [1 point each], hypertension [1 point], elderly [age ≥75 years, 2 points], systolic heart failure [2 points], thyroid disease [1 point]) score in predicting SAHREs in patients with cardiac implantable electronic devices without atrial fibrillation.Methods and ResultsFive Hundred consecutive patients with cardiac implantable electronic devices in the West Birmingham Atrial Fibrillation Project in the United Kingdom were followed since the procedure to observe the development of SAHREs, defined by atrial high‐rate episodes lasting >24 hours. Risk factors and incidence of SAHREs were analyzed. The predictive value of the C₂HEST score for SAHRE prediction was evaluated. Over a mean follow‐up of 53.1 months, 44 (8.8%) patients developed SAHREs. SAHREs were associated with higher all‐cause mortality (P<0.001) and ischemic stroke (P=0.001). Age and heart failure were associated with SAHRE occurrence. The incidence of SAHREs increased by the C₂HEST score (39% higher risk per point increase). Among patients with a C₂HEST score ≥4, the incidence of SAHREs was 3.62% per year (95% CI, 2.14–5.16). The C₂HEST score had moderate predictive capability (area under the curve, 0.73; 95% CI, 0.64–0.81) and discriminative ability (log‐rank P=0.003), which was better than other clinical scores (CHA₂DS₂‐VASc, CHADS₂, HATCH).ConclusionsThe C₂HEST score predicted SAHRE incidence in patients without atrial fibrillation who had an cardiac implantable electronic device, with the highest risk seen in patients with a C₂HEST score ≥4 The benefit of using the C₂HEST score in clinical practice in this patient population needs further investigation.

更新日期：2021-03-16

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