Value of Combining Left Atrial Diameter and Amino?terminal Pro?brain Natriuretic Peptide to the CHA2DS2?VASc Score for Predicting Stroke and Death in Patients with Sick Sinus Syndrome after Pacemaker Implantation

摘要

Background: The CHA2DS2?VASc score is used clinically for stroke risk stratification in atients 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 mplantation 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 31, 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 < 0.001) 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 0.61–0.77 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.