Purpose:This study was aimed at evaluating the safety and efficacy of warfarin versus rivaroxaban in patients with atrial fibrillation(AF)and different CHA2DS2-VASc score subgroups in northern China.Methods:A retrospe...Purpose:This study was aimed at evaluating the safety and efficacy of warfarin versus rivaroxaban in patients with atrial fibrillation(AF)and different CHA2DS2-VASc score subgroups in northern China.Methods:A retrospective cohort study was conducted to evaluate 387 patients with AF who received treatment at our institution between September 2018 and August 2019.The patients were divided into two groups receiving either warfarin(n=194)or rivaroxaban(n=193).Follow-up data were collected,including adherence,bleeding and ischemic stroke events.Results:The group receiving rivaroxaban showed better adherence than the group receiving warfarin.In the warfarin-treated group,bleeding incidents declined with increasing scores.In the warfarin-treated group,patients with scores of 2–3 had greater adherence and fewer stroke occurrences.The events of bleeding and stroke did not significantly differ in patients in the rivaroxaban-treated group with different scores.Conclusions:Compared with patients in the warfarin group with different CHA2DS2-VASc scores,those in the rivaroxaban group had greater compliance,and fewer bleeding and stroke events.Regardless of economic considera-tions,rivaroxaban is preferable for anticoagulative AF treatment in northern Chinese patients.展开更多
Background： The CHA2DS2-VASc score is used clinically for stroke risk stratification in patients with atrial fibrillation （AF）. We sought to investigate whether the CHA2DS2-VASc score predicts stroke and death in C...Background： The CHA2DS2-VASc score is used clinically for stroke risk stratification in patients with atrial fibrillation （AF）. We sought to investigate whether the CHA2DS2-VASc score predicts stroke and death in Chinese patients with sick sinus syndrome （SSS） after pacemaker implantation and to evaluate whether the predictive power of the CHA2DS2-VASc score could be improved by combining it with left atrial diameter （LAD） and amino-terminal pro-brain natriuretic peptide （NT-proBNP）. Methods： A total of 481 consecutive patients with SSS who underwent pacemaker implantation from January 2004 to December 2014 in our department were included. The CHA2DS2-VASc scores were retrospectively calculated according to the hospital medical records before pacemaker implantation. The outcome data （stroke and death） were collected by pacemaker follow-up visits and telephonic follow-up until December 3 l, 2015. Results： During 2151 person-years of follow-up, 46 patients （9.6%） suffered stroke and 52 （10.8%） died. The CHA2DS2-VASc score showed a significant association with the development of stroke （hazard ratio [HR] 1.45, 95% confidence interval [CI] 1.20-1.75, P 〈 0.00 1） and death （HR 1.45, 95% CI 1.22-1.71, P 〈 0.001）. The combination of increased LAD and the CHA2DS2-VASc score improved the predictive power for stroke （C-stat 0.69, 95% CI 0.61-4）.77 vs. C-stat 0.66, 95% CI 0.57-0.74, P = 0.013）, and the combination of increased NT-proBNP and the CHA2DS2-VASc score improved the predictive power for death （C-stat 0.70, 95% CI 0.64-0.77 vs. C-stat 0.67, 95% CI 0.60--0.75, P= 0.023）. Conclusions： CHA2DS2-VASc score is valuable for predicting stroke and death risk in patients with SSS after pacemaker implantation. The addition of LAD and NT-proBNP to the CHA2DS2-VASc score improved its predictive power for stroke and death, respectively, in this patient cohort. Future prospective studies are warranted to validate the benefit of adding LAD and NT-proBNP to the CHA2DS2-VASc score for predicting stroke and death risk in non-AF populations.展开更多
基金The study was funded by the National Natural Science Foundation of China(No.81900366)the Postdoctoral Initiation Foundation of Heilongjiang Province(LBH-Q19032)the Research Project of the First Affiliated Hospital of Harbin Medical University(2021J01).
文摘Purpose:This study was aimed at evaluating the safety and efficacy of warfarin versus rivaroxaban in patients with atrial fibrillation(AF)and different CHA2DS2-VASc score subgroups in northern China.Methods:A retrospective cohort study was conducted to evaluate 387 patients with AF who received treatment at our institution between September 2018 and August 2019.The patients were divided into two groups receiving either warfarin(n=194)or rivaroxaban(n=193).Follow-up data were collected,including adherence,bleeding and ischemic stroke events.Results:The group receiving rivaroxaban showed better adherence than the group receiving warfarin.In the warfarin-treated group,bleeding incidents declined with increasing scores.In the warfarin-treated group,patients with scores of 2–3 had greater adherence and fewer stroke occurrences.The events of bleeding and stroke did not significantly differ in patients in the rivaroxaban-treated group with different scores.Conclusions:Compared with patients in the warfarin group with different CHA2DS2-VASc scores,those in the rivaroxaban group had greater compliance,and fewer bleeding and stroke events.Regardless of economic considera-tions,rivaroxaban is preferable for anticoagulative AF treatment in northern Chinese patients.
基金This work was supported by grants from the State Key Program of National Natural Science Foundation of China （No. 81530015）, National Natural Science Foundation of China grant （No. 81270258）, and Shanghai City Committee of Science and Technology Research Projects （Nos. 12411951900, 13140903801, and 14441902502）.
文摘Background： The CHA2DS2-VASc score is used clinically for stroke risk stratification in patients with atrial fibrillation （AF）. We sought to investigate whether the CHA2DS2-VASc score predicts stroke and death in Chinese patients with sick sinus syndrome （SSS） after pacemaker implantation and to evaluate whether the predictive power of the CHA2DS2-VASc score could be improved by combining it with left atrial diameter （LAD） and amino-terminal pro-brain natriuretic peptide （NT-proBNP）. Methods： A total of 481 consecutive patients with SSS who underwent pacemaker implantation from January 2004 to December 2014 in our department were included. The CHA2DS2-VASc scores were retrospectively calculated according to the hospital medical records before pacemaker implantation. The outcome data （stroke and death） were collected by pacemaker follow-up visits and telephonic follow-up until December 3 l, 2015. Results： During 2151 person-years of follow-up, 46 patients （9.6%） suffered stroke and 52 （10.8%） died. The CHA2DS2-VASc score showed a significant association with the development of stroke （hazard ratio [HR] 1.45, 95% confidence interval [CI] 1.20-1.75, P 〈 0.00 1） and death （HR 1.45, 95% CI 1.22-1.71, P 〈 0.001）. The combination of increased LAD and the CHA2DS2-VASc score improved the predictive power for stroke （C-stat 0.69, 95% CI 0.61-4）.77 vs. C-stat 0.66, 95% CI 0.57-0.74, P = 0.013）, and the combination of increased NT-proBNP and the CHA2DS2-VASc score improved the predictive power for death （C-stat 0.70, 95% CI 0.64-0.77 vs. C-stat 0.67, 95% CI 0.60--0.75, P= 0.023）. Conclusions： CHA2DS2-VASc score is valuable for predicting stroke and death risk in patients with SSS after pacemaker implantation. The addition of LAD and NT-proBNP to the CHA2DS2-VASc score improved its predictive power for stroke and death, respectively, in this patient cohort. Future prospective studies are warranted to validate the benefit of adding LAD and NT-proBNP to the CHA2DS2-VASc score for predicting stroke and death risk in non-AF populations.
