房颤卒中风险评分预测左心耳封堵术后患者缺血风险的外部验证

    External validation of atrial fibrillation stroke risk scores for predicting ischemic risk in patients after left atrial appendage occlusion

      摘要
    • 摘要:
      目的 外部评估房颤卒中风险评分对左心耳封堵（left atrial appendage occlusion，LAAO）术后患者缺血风险的预测能力。
      方法 前瞻性纳入2019年4月1日～2020年10月31日在39家医院成功接受LAAO治疗的房颤患者，共3082例。通过C统计量、受试者工作特征（receiver operating characteristic，ROC）曲线、Hosmer-Lemeshow检验和校准曲线，对比7个房颤卒中风险评分，预测术后1年缺血风险的区分度和校准度。房颤卒中风险评分包括CHADS2、Modified-CHADS2、CHA2DS2-VASc、ATRIA、mCHA2DS2-VASc、GARFIELD-AF和GARFIELD-AF II评分。
      结果 随访1年，74例（2.4%）患者发生卒中，其中52例（1.7%）为缺血性卒中，4例（0.1%）患者发生体循环栓塞（systemic embolism，SE），133例（4.3%）患者发生死亡/卒中/SE复合终点。在7个评分中，GARFIELD-AF II评分在预测卒中，缺血性卒中，卒中/SE和死亡/卒中/SE时均具有数值上最高的区分度（C统计量：0.685、0.675、0.685、0.692）。此外，Hosmer-Lemeshow检验和校准曲线显示GARFIELD-AF II评分预测LAAO术后患者缺血性卒中的校准度良好（χ2=3.150）。
      结论  GARFIELD-AF II评分具有较好的区分度和校准度，可作为预测LAAO术后房颤患者卒中风险的工具。

       

      Abstract:
      AIM To externally validate the atrial fibrillation (AF) stroke risk scores for predicting ischemic risk in patients following left appendage occlusion (LAAO).
      METHODS From April 1, 2019, to October 31, 2020, a total of 3,082 AF patients who underwent successful LAAO at 39 hospitals were prospectively included. The discriminatory and calibration abilities of seven AF stroke risk scores — CHADS2, Modified-CHADS2, CHA2DS2-VASc, ATRIA, mCHA2DS2-VASc, GARFIELD-AF, and GARFIELD-AF II — were evaluated for predicting 1-year postoperative ischemic risk using the C-statistic, receiver operating characteristic (ROC) curve, Hosmer-Lemeshow test, and calibration curves.
      RESULTS  At 1-year follow-up, 74 patients (2.4%) experienced stroke, of whom 52 (1.7%) had ischemic stroke, 4 (0.1%) had systemic embolism (SE), and the composite endpoint of death/stroke/SE occurred in 133 (4.3%) patients. Among the seven scores, the GARFIELD-AF II score demonstrated the highest discriminative ability in predicting stroke, ischemic stroke, stroke/SE, and death/stroke/SE (C-statistics: 0.685, 0.675, 0.685, and 0.692, respectively). Furthermore, the Hosmer-Lemeshow test and calibration curves indicated that the GARFIELD-AF II score was well-calibrated for predicting ischemic stroke in patients after LAAO (χ2 = 3.150).
      CONCLUSION The GARFIELD-AF II score exhibits strong discriminatory and calibration properties, making it a reliable tool for predicting stroke risk in AF patients following LAAO.

       

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