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Prediction of early recurrent thromboembolic event and major bleeding in patients with acute stroke and atrial fibrillation by a risk stratification schema: the ALESSA score study

机译:通过危险分层方案预测急性卒中和心房颤动患者早期复发性血栓栓塞事件和大出血:aLEssa评分研究

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摘要

Background and Purposes—This study was designed to derive and validate a score to predict early ischemic events and major bleedings after an acute ischemic stroke in patients with atrial fibrillation.ududMethods—The derivation cohort consisted of 854 patients with acute ischemic stroke and atrial fibrillation included in prospective series between January 2012 and March 2014. Older age (hazard ratio 1.06 for each additional year; 95% confidence interval, 1.00–1.11) and severe atrial enlargement (hazard ratio, 2.05; 95% confidence interval, 1.08–2.87) were predictors for ischemic outcome events (stroke, transient ischemic attack, and systemic embolism) at 90 days from acute stroke. Small lesions (≤1.5 cm) were inversely correlated with both major bleeding (hazard ratio, 0.39; P=0.03) and ischemic outcome events (hazard ratio, 0.55; 95% confidence interval, 0.30–1.00). We assigned to age ≥80 years 2 points and between 70 and 79 years 1 point; ischemic index lesion >1.5 cm, 1 point; severe atrial enlargement, 1 point (ALESSA score). A logistic regression with the receiver-operating characteristic graph procedure (C statistic) showed an area under the curve of 0.697 (0.632–0.763; P=0.0001) for ischemic outcome events and 0.585 (0.493–0.678; P=0.10) for major bleedings.ududResults—The validation cohort consisted of 994 patients included in prospective series between April 2014 and June 2016. Logistic regression with the receiver-operating characteristic graph procedure showed an area under the curve of 0.646 (0.529–0.763; P=0.009) for ischemic outcome events and 0.407 (0.275–0.540; P=0.14) for hemorrhagic outcome events.ududConclusions—In acute stroke patients with atrial fibrillation, high ALESSA scores were associated with a high risk of ischemic events but not of major bleedings.
机译:背景与目的-本研究旨在推导并验证评分,以预测房颤患者急性缺血性卒中后的早期缺血事件和重大出血。 ud ud方法-衍生队列由854例急性缺血性卒中和卒中患者组成。心房颤动包括在2012年1月至2014年3月的前瞻性研究中。年龄较大(每增加一年的危险比1.06; 95%可信区间1.00-1.11)和严重的心房扩大(危险比2.05; 95%可信区间1.08-1.0) 2.87)是急性卒中90天后缺血预后事件(中风,短暂性脑缺血发作和全身性栓塞)的预测指标。小病变(≤1.5cm)与大出血(危险比,0.39; P = 0.03)和缺血性结果事件(危险比,0.55; 95%置信区间,0.30–1.00)呈负相关。我们给年龄≥80岁的2分,以及70到79岁的1分;缺血指数病变> 1.5 cm,1个点;严重心房扩大,为1分(ALESSA评分)。接受者操作特征图程序的逻辑回归(C统计量)显示缺血性结果事件的曲线下面积为0.697(0.632–0.763; P = 0.0001),严重出血的曲线下面积为0.585(0.493–0.678; P = 0.10) 。 ud ud结果-验证队列由2014年4月至2016年6月之间的994例前瞻性研究系列组成。采用接受者操作特征图法进行Logistic回归分析显示曲线下面积为0.646(0.529-0.763; P = 0.009) )导致缺血性预后事件,而出血性预后事件为0.407(0.275–0.540; P = 0.14)。 ud ud结论—急性卒中合并心房颤动的患者,较高的ALESSA评分与缺血性事件的高风险相关,但与重大事件无关流血。

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