评价房颤CHADS_2评分及其衍生评分对冠心病及其严重程度的预测价值

Prediction of coronary artery disease severity using CHADS_2, CHA_2DS_2-VASc and CHA_2DS_2-VASc-HSF scores

目的探讨房颤评分系统CHADS2（欧洲）评分及其衍生评分对冠心病及其严重程度的预测价值。方法纳入2013年1月1日-2013年12月1日就诊于本院心血管内科怀疑冠心病并行冠状动脉造影检查的连续病例429例,根据其造影结果分为对照组（n=51）及冠心病组（n=378）。根据患者的临床资料计算其CHADS2、CHA2DS2-VASc和CHA2DS2-VASc-HSF评分,根据其冠状动脉造影结果计算Gensini积分评价其病变严重程度,并对3种评分的冠心病预测能力进行评价。结果 CHADS2、CHA2DS2-VASc和CHA2DS2-VASc-HSF评分与病变支数（r=0.317,P〈0.01;r=0.332,P〈0.01;r=0.330,P〈0.01）及Gensini积分均有一定相关性（r=0.240,P〈0.01;r=0.274,P〈0.01;r=0.295,P〈0.01）。截断点分析显示,CHA2DS2-VASc-HSF评分≥3对冠心病的预测价值最高,其灵敏度、特异度、曲线下面积分别为0.860、0.804、0.832（95%CI：0.766-0.898）。结论 CHADS2及其衍生评分对冠心病有一定的预测价值,尤其是CHA2DS2-VASc-HSF评分≥3对冠心病有较高的预测价值。

Objective To determine the value of CHADS2, CHA2DS2-VASc and CHA2DS2-VASc-HSF scores for prediction of CAD severity.Methods Clinical data about 429 patients who underwent coronary angiography in the department of cardiology in Chinese PLA General Hospital from January 2013 to December 2013 were collected. These patients were divided into control group （n=51） and CAD group （n=378） based on the result of CAG. According to the clinical data, CHADS2, CHA2DS2-VASc and CHA2DS2-VASc-HSF scores were respectively calculated. Furthermore, AUC were calculated to access the predictive ability of three kinds of scores.ResultsThe CHADS2, CHA2DS2-VASc and CHA2DS2-VASc-HSF scores were correlated with the number of diseased vessels （r=0.317,P〈0.01;r=0.332,P〈0.01;r=0.330,P〈0.01, respectively） and the Gensini score （r=0.240,P〈0.01;r=0.274, P〈0.01;r=0.295,P〈0.01, respectively）. For prediction of CAD, the cut-off value of CHA2DS2-VASc-HSF score was≥3 with a sensitivity of 86.0% and a specificity of 80.4% （AUC 0.832, 95%CI 0.766 to 0.898,P〈0.001）.Conclusion CHADS2, CHA2DS2-VASc and especially CHA2DS2-VASc-HSF score can predict the individual risk of developing CAD.