Objectives The CHA2DS2-VASc score is the preferred risk model for anticoagulation decision-making in atrial fibrillation (AF) patients. Recent studies have found this score to have prognostic value in other cardiovascular diseases. We assessed the relationships between CHA2DS2-VASc score and long-term mortality in adults referred for stress testing, Methods 165 184 consecutive patients from January 1991 to December 2014 from a prospective registry were studied, with CHA2DS2-VASc score calculated for all patients, and AF and anticoagulation status were recorded. The primary endpoint was all-cause mortality. Results In this cohort, 12 450 (7.5%) patients had AF and mean CHA2DS2-VASc score was 2.2±1.2. There were 22 152 (18.4%) deaths during mean follow-up of 6.1±4.8 years. In multivariable analysis, CHA2DS2-VASc score, presence of AF and anticoagulation use, along with end-stage renal failure and smoking were all independently associated with mortality with HRs (95% CIs) of 1.23 (1.21 to 1.25), 1.18 (1.10 to 1.27) and 1.50 (1.40 to 1.60), respectively. Higher CHA2DS2-VASc score was incrementally associated with worse survival both in patients with and without AF (log-rank p<0.001). Anticoagulation use was associated with reduced survival in non-AF patients with alternative anticoagulation indications at all CHA2DS2-VASc score categories, and AF patients with lower CHA2DS2-VASc score 0–2, but was protective in AF patients with higher CHA2DS2-VASc score 4–9. Conclusion Incrementally higher CHA2DS2-VASc score, a simple clinical tool, is associated with mortality in patients regardless of presence of AF and anticoagulation status. Anticoagulation use was associated with worse survival in non-AF patients and AF patients with low CHA2DS2-VASc scores, but was protective in AF patients with high CHA2DS2-VASc scores. All data relevant to the study are included in the article or uploaded as online supplemental information.

中文翻译：

---

CHA2DS2-VASc 评分对患有和不患有房颤的患者的死亡风险进行分层


目的 CHA2DS2-VASc 评分是房颤 (AF) 患者抗凝决策的首选风险模型。最近的研究发现该评分对其他心血管疾病具有预后价值。我们评估了进行压力测试的成年人的 CHA2DS2-VASc 评分与长期死亡率之间的关系，方法对前瞻性登记中 1991 年 1 月至 2014 年 12 月的 165 184 名连续患者进行了研究，计算了所有患者的 CHA2DS2-VASc 评分，并且记录 AF 和抗凝状态。主要终点是全因死亡率。结果 在该队列中，12 450 名 (7.5%) 患者患有 AF，平均 CHA2DS2-VASc 评分为 2.2±1.2。在平均 6.1±4.8 年的随访期间，共有 22 152 人（18.4%）死亡。在多变量分析中，CHA2DS2-VASc 评分、房颤的存在和抗凝治疗以及终末期肾功能衰竭和吸烟均与死亡率独立相关，HR（95% CI）分别为 1.23（1.21 至 1.25）、1.18（1.10 至 1.10）。分别为 1.27）和 1.50（1.40 至 1.60）。较高的 CHA2DS2-VASc 评分与患有和不患有 AF 的患者的生存率较差相关（对数秩 p<0.001）。在所有 CHA2DS2-VASc 评分类别中，具有替代抗凝适应症的非 AF 患者以及 CHA2DS2-VASc 评分较低 0-2 的 AF 患者中，抗凝治疗的使用与生存率降低相关，但对于 CHA2DS2-VASc 评分较高 4 的 AF 患者具有保护作用–9。结论 CHA2DS2-VASc 评分是一种简单的临床工具，逐渐升高与患者死亡率相关，无论是否存在 AF 和抗凝状态如何。 抗凝治疗的使用与非 AF 患者和 CHA2DS2-VASc 评分低的 AF 患者的生存较差相关，但对 CHA2DS2-VASc 评分高的 AF 患者具有保护作用。与研究相关的所有数据都包含在文章中或作为在线补充信息上传。