Background

The CHA₂DS₂-VASc score has been associated with the prognosis of cardiovascular diseases. This study aimed to explore the association between the CHA₂DS₂-VASc score and all-cause mortality in coronary care unit (CCU) patients.

Methods

The study was based on the Medical Information Mart for Intensive Care (MIMIC) III database. CCU patients were divided into two groups according to CHA₂DS₂-VASc score: 0-3 (low risk)，4-9 (intermediate and high risk). The primary outcome was 30-day mortality, and the secondary endpoints included in-hospital, 1-year, and 5-year mortality. Propensity score matching (PSM) and sensitivity analyzes for the confounders were also performed. The restricted cubic splines flexibility model was used to demonstrate the relation between red blood cell volume distribution width (RDW), blood urea nitrogen (BUN), platelet, white blood cell (WBC), hemoglobin, phosphorus, glucose, potassium, sodium and 30-day mortality in the 0-3 score versus the 4-9 score groups after PSM.

Results

Among 4491 eligible patients, 988 patients with low CHA₂DS₂-VASc scores and 988 patients with intermediate and high CHA₂DS₂-VASc scores had similar propensity scores and were included in the analyzes. In the survival analysis, the patients with intermediate and high CHA₂DS₂-VASc scores were associated with higher 30-day mortality [hazard ratio (HR): 1.11; 95% confidence interval (CI), 1.02–1.20, P = .014], 1-year mortality [HR: 1.13; 95%CI, 1.06–1.19, P < .001], and 5-year mortality [HR: 1.13; 95%CI, 1.07–1.18, P < .001]. The interaction for 30-day mortality among subgroups was not significant between the 0-3 score versus the 4-9 score groups. The restricted cubic splines for 30-day mortality demonstrated an L-shaped trajectory for platelets and hemoglobin, a J-shaped trajectory for WBC, glucose and potassium, and a U-shaped trajectory for sodium, respectively (all nonlinear P <.001).

Conclusions

A high CHA₂DS₂-VASc score was an independent risk for 30-day, 1-year, and 5-year mortality for CCU patients.

中文翻译：

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冠心病病房患者高 CHA2DS2-VASc 评分与短期和长期死亡率之间的关联

背景

CHA ₂ DS ₂ -VASc 评分与心血管疾病的预后相关。本研究旨在探讨 CHA ₂ DS ₂ -VASc 评分与冠状动脉监护病房 (CCU) 患者全因死亡率之间的关系。

方法

该研究基于重症监护医学信息集市 (MIMIC) III 数据库。CCU患者根据CHA ₂ DS ₂ -VASc评分分为两组：0-3（低风险），4-9（中高风险）。主要结局是 30 天死亡率，次要终点包括住院、1 年和 5 年死亡率。还对混杂因素进行了倾向评分匹配 (PSM) 和敏感性分析。使用受限三次样条柔度模型来证明红细胞体积分布宽度（RDW）、血尿素氮（BUN）、血小板、白细胞（WBC）、血红蛋白、磷、葡萄糖、钾、钠和30之间的关系。 PSM 后 0-3 分组与 4-9 分组的 - 天死亡率。

结果

在 4491 名符合条件的患者中，988 名 CHA ₂ DS _{2 -VASc 评分低的患者和 988 名 CHA 2} DS ₂ -VASc 评分中等和高的患者具有相似的倾向评分并被纳入分析。在生存分析中，具有中等和高 CHA ₂ DS ₂ -VASc 评分的患者与较高的 30 天死亡率相关[风险比 (HR)：1.11；95% 置信区间 (CI), 1.02–1.20, P  = .014], 1 年死亡率 [HR: 1.13; 95%CI, 1.06–1.19, P  < .001] 和 5 年死亡率 [HR: 1.13; 95%CI，1.07–1.18，P < .001]。0-3 分组与 4-9 分组之间 30 天死亡率的交互作用不显着。30 天死亡率的受限三次样条曲线分别显示血小板和血红蛋白的 L 形轨迹，WBC、葡萄糖和钾的 J 形轨迹以及钠的 U 形轨迹（所有非线性P <.001） .

结论

高 CHA ₂ DS ₂ -VASc 评分是 CCU 患者 30 天、1 年和 5 年死亡率的独立风险。