Circulation Journal ( IF 3.1 ) Pub Date : 2021-07-21 , DOI: 10.1253/circj.cj-20-1075 Ken Okumura 1, 2 , Hirofumi Tomita 1 , Michikazu Nakai 3 , Eitaro Kodani 4 , Masaharu Akao 5 , Shinya Suzuki 6 , Kenshi Hayashi 7 , Mitsuaki Sawano 8 , Masahiko Goya 9 , Takeshi Yamashita 6 , Keiichi Fukuda 8 , Hisashi Ogawa 5 , Toyonobu Tsuda 7 , Mitsuaki Isobe 9, 10 , Kazunori Toyoda 11 , Yoshihiro Miyamoto 3, 12 , Hiroaki Miyata 13 , Tomonori Okamura 14 , Yusuke Sasahara 3 ,
Background:Recently, identification of independent risk factors for ischemic stroke in Japanese non-valvular atrial fibrillation (NVAF) patients was made by analyzing the 5 major Japanese registries: J-RHYTHM Registry, Fushimi AF Registry, Shinken Database, Keio interhospital Cardiovascular Studies, and the Hokuriku-Plus AF Registry.
Methods and Results:The predictive value of the risk scheme in Japanese NVAF patients was assessed. Of 16,918 patients, 12,289 NVAF patients were analyzed (mean follow up, 649±181 days). Hazard ratios (HRs) of each significant, independent risk factor were determined by using adjusted Cox-hazard proportional analysis. Scoring system for ischemic stroke was created by transforming HR logarithmically and was estimated by c-statistic. During the 21,820 person-years follow up, 241 ischemic stroke events occurred. Significant risk factors were: being elderly (aged 75–84 years [E], HR=1.74), extreme elderly (≥85 years [EE], HR=2.41), having hypertension (H, HR=1.60), previous stroke (S, HR=2.75), type of AF (persistent/permanent) (T, HR=1.59), and low body mass index <18.5 kg/m2(L, HR=1.55) after adjusting for oral anticoagulant treatment. The score was assigned as follows: 1 point to H, E, L, and T, and 2 points to EE and S (HELT-E2S2score). The C-statistic, using this score, was 0.681 (95% confidence interval [CI]=0.647–0.714), which was significantly higher than those using CHADS2(0.647; 95% CI=0.614–0.681, P=0.027 for comparison) and CHA2DS2-VASc scores (0.641; 95% CI=0.608–0.673, P=0.008).
Conclusions:The HELT-E2S2score may be useful for identifying Japanese NVAF patients at risk of ischemic stroke.
中文翻译：
日本非瓣膜性心房颤动患者缺血性卒中的新型风险分层系统
背景：最近，通过分析日本的 5 个主要注册机构：J-RHYTHM Registry、Fushimi AF Registry、Shinken Database、Keio interhospital Cardiovascular Studies、和 Hokuriku-Plus AF 注册表。
方法和结果：评估风险方案在日本 NVAF 患者中的预测价值。在 16,918 名患者中，对 12,289 名 NVAF 患者进行了分析（平均随访时间为 649±181 天）。通过使用调整后的 Cox 风险比例分析确定每个重要的独立风险因素的风险比 (HR)。缺血性中风的评分系统是通过对数转换 HR 来创建的，并通过 c 统计量进行估计。在 21,820 人年的随访中，发生了 241 起缺血性卒中事件。显着的危险因素是：高龄（75-84岁[E]，HR=1.74），极度高龄（≥85岁[EE]，HR=2.41），有高血压（H，HR=1.60），既往中风（ S，HR=2.75），AF 类型（持续/永久性）（T，HR=1.59），低体重指数 <18.5 kg/m 2(L, HR=1.55) 调整口服抗凝剂治疗后。分数分配如下：H、E、L 和 T 为 1 分，EE 和 S 为 2 分（HELT-E 2 S 2分数）。使用该分数的 C 统计量为 0.681（95% 置信区间 [CI]=0.647–0.714），显着高于使用 CHADS 2的结果（0.647；95% CI=0.614–0.681，P=0.027 用于比较) 和 CHA 2 DS 2 -VASc 评分 (0.641; 95% CI=0.608–0.673, P=0.008)。
结论： HELT-E 2 S 2评分可能有助于识别有缺血性卒中风险的日本 NVAF 患者。
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