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A Novel Risk Stratification System for Ischemic Stroke in Japanese Patients With Non-Valvular Atrial Fibrillation

Okumura, Ken ; Tomita, Hirofumi ; Nakai, Michikazu ; Kodani, Eitaro ; Akao, Masaharu ; Suzuki, Shinya ; Hayashi, Kenshi ; Sawano, Mitsuaki ; Goya, Masahiko ; Yamashita, Takeshi ; Fukuda, Keiichi ; Ogawa, Hisashi ; Tsuda, Toyonobu ; Isobe, Mitsuaki ; Toyoda, Kazunori ; Miyamoto, Yoshihiro ; Miyata, Hiroaki ; Okamura, Tomonori ; Sasahara, Yusuke ; for the J-RISK AF Research Group

Circulation Journal, 2021/03/25, pp.CJ-20-1075 [Revista revisada por pares]

The Japanese Circulation Society

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Título:
A Novel Risk Stratification System for Ischemic Stroke in Japanese Patients With Non-Valvular Atrial Fibrillation
Autor: Okumura, Ken ; Tomita, Hirofumi ; Nakai, Michikazu ; Kodani, Eitaro ; Akao, Masaharu ; Suzuki, Shinya ; Hayashi, Kenshi ; Sawano, Mitsuaki ; Goya, Masahiko ; Yamashita, Takeshi ; Fukuda, Keiichi ; Ogawa, Hisashi ; Tsuda, Toyonobu ; Isobe, Mitsuaki ; Toyoda, Kazunori ; Miyamoto, Yoshihiro ; Miyata, Hiroaki ; Okamura, Tomonori ; Sasahara, Yusuke ; for the J-RISK AF Research Group
Materias: Anticoagulants ; Atrial fibrillation ; Risk stratification ; Scoring system ; Stroke
Es parte de: Circulation Journal, 2021/03/25, pp.CJ-20-1075
Descripción: 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.
Editor: The Japanese Circulation Society
Idioma: Inglés

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A Novel Risk Stratification System for Ischemic Stroke in Japanese Patients With Non-Valvular Atrial Fibrillation

The Japanese Circulation Society

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