Ken Okumura1,2, Hirofumi Tomita1, Michikazu Nakai3, Eitaro Kodani4, Masaharu Akao5, Shinya Suzuki6, Kenshi Hayashi7, Mitsuaki Sawano8, Masahiko Goya9, Takeshi Yamashita6, Keiichi Fukuda8, Hisashi Ogawa5, Toyonobu Tsuda7, Mitsuaki Isobe9,10, Kazunori Toyoda11, Yoshihiro Miyamoto3,12, Hiroaki Miyata13, Tomonori Okamura14, Yusuke Sasahara3. 1. Department of Cardiology, Hirosaki University Graduate School of Medicine. 2. Division of Cardiology, Saiseikai Kumamoto Hospital. 3. Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center. 4. Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital. 5. Department of Cardiology, National Hospital Organization Kyoto Medical Center. 6. Department of Cardiovascular Medicine, The Cardiovascular Institute. 7. Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Science. 8. Department of Cardiology, Keio University School of Medicine. 9. Department of Cardiovascular Medicine, Tokyo Medical and Dental University. 10. Sakakibara Heart Institute. 11. Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center. 12. Department of Preventive Cardiology, National Cerebral and Cardiovascular Center. 13. Department of Health Policy and Management School of Medicine, Keio University. 14. Department of Preventive Medicine and Public Health, Keio University School of Medicine.
Abstract
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.
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.