三种评分对心房颤动导管消融术后复发的预测价值比较

Comparisons of three kinds of scores in predicting recurrence after atrial fibrillation cathctcr ablation

目的探讨CAAP-AF评分、APPLE评分和CHA2DS2.VASc评分对房颤导管消融术后复发的预测价值。方法纳入2014年1月至2017年6月在中国医科大学附属第一医院行房颤消融术的251例患者并进行术后随访,根据术后3个月后是否再次发生任何持续至少30S的房性心律失常,将患者分为复发组和未复发组。分别计算每位患者CAAP-AF评分、APPLE评分及CHA2DS2-VASc评分分值,并对评分及一般资料等结果进行统计学分析。结果三种评分对房颤导管消融术后复发均有一定预测价值,其ROC曲线下面积(Auc)均>O.5(P<0.05),随着评分的增高,复发率逐渐增高(趋势P值均<0.05);两两比较表明,CAAP-AF评分的预测价值最佳(P<0.05),其最佳截断点为≥5分,灵敏度为65.1%,特异度为65.5%。其余评分预测价值之间无统计学差异(P>0.05)。Logistic回归分析表明,CAAP-AF评分(OR=1.356,P<0.001)及CHA2DS2-VASc评分(OR=1.241,P=0.049)为房颤消融术后复发的独立危险因素。结论三种评分对房颤消融术后复发均有一定预测价值,其中CAAP-AF评分预测价值最佳。

Objective To evaluate the predictive values of CAAP-AF score,APPLE score and CHA2DS2- VASc score in recurrence after catheter ablation of atrial fibrillation (AF).Methods 251 patients underwent AF ablation in the First Affiliated Hospital of China Medical University from January 2014to June 2017were included.The patients were divided into the recurrence group and non-recurrent group according to whether they had the recurrence of any atrial arrhythmia lasting over 30seconds after 3months post-operation.The scores of CAAP-AF,APPLE and CHA2DS2-VASc of each patient were calculated respectively and the scores and general data were analyzed statistically.Results The three scores all showed some predictive value for recurrence after catheter ablation of AF.The area under the ROC curve (AUC)were all >0.5(P<0.05).As the score increased, the recurrence rate gradually increased (P for trend were all <0.05).Pairwise comparison showed that the predicted value of CAAP-AF score was optimal (P<0.05)with the best cut-off point being≥ 5 points,sensitivity being 65.1% and specificity being 65.5%.There was no statistical difference between the predicted values for the remaining two scores (P>0.05).Logistic regression analysis showed that the CAAP-AF score (OR=1.356,P< 0.001)and the CHA2DS2-VASc score (OR=1.241,P=0.049)were independent risk factors for the recurrence after AF ablation.Condusion All scores showed some predictive value for the recurrence after AF ablation and CAAP- AF score is the best predictor.