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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Risk Prediction for Ischemic Stroke and Transient Ischemic Attack in Patients Without Atrial Fibrillation: A Retrospective Cohort Study
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Risk Prediction for Ischemic Stroke and Transient Ischemic Attack in Patients Without Atrial Fibrillation: A Retrospective Cohort Study

机译：没有心房颤动的患者缺血性卒中和短暂性缺血攻击风险预测：回顾性队列研究

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Background: Stroke mainly occurs in patients without atrial fibrillation (AF). This study explored risk prediction models for ischemic stroke and transient ischemic attack (TIA) in patients without AF. Methods: Three US-based healthcare data-bases (Truven MarketScan Commercial Claims and Encounters [CCAE], Medicare Supplemental [MDCR], and Optum Clinformatics [Optum]) were used to establish patient cohorts without AF during the index period of 2008-2012. The performance of 2 existing models (CHADS2 and CHA2DS2-VASc) for predicting stroke and TIA was examined by fitting a logistic regression to a training dataset and evaluating predictive accuracy in a validation dataset (area under the curve, AUC) using patients with complete follow-up of 1 or 3 years, separately. Results: The commercial populations were younger and had fewer comorbidities than Medicare-eligible population. The incidence proportions of ischemic stroke and TIA during 1 and 3 years of follow-up were .5% and 1.9% (CCAE),.6% and 2.2% (Optum), and 4.6% and 13.1% (MDCR), respectively. The models performed consistently across all 3 databases, with the AUC ranging from .69 to .77 and from .68 to .73 for 1- and 3-year prediction, respectively. Predictive accuracy was lower than the initial work of CHADS2 evaluation in patients with AF (AUC: .82), but consistent with a subsequent meta-analysis of CHADS2 (.60-.80) and CHA2DS2-VASc performance (.64-.79). Conclusion: Although the existing schemes for predicting ischemic stroke and TIA in patients with AF can be applied to patients without AF with comparable predictive accuracy, the evidence suggests that there is room for improvement in these models' performance. (C) 2017 The Authors. Published by Elsevier Inc.
机译：背景：卒中主要发生在没有心房颤动的患者中（AF）。本研究探讨了没有AF的患者缺血性卒中和短暂性缺血性发作（TIA）的风险预测模型。方法：三种美国医疗保健数据库（Truven Marketscan商业索赔和遇到[CCAE]，Medicare补充[MDCr]，以及opolum Cloudformatics [opolum]）用于在2008-2012的指数期间建立没有AF的患者队列。通过将Logistic回归拟合到训练数据集的逻辑回归和使用完整的患者评估验证数据集（AUC下的区域）中的预测精度来检查用于预测行程和TIA的现有模型（CHADS2和CHA2S2-VASC）。分别为1或3年。结果：商业人口较年轻，少于Medicare符合条件的人群。缺血性卒中和TIA的发生率比例在1和3年后的后续均为0.5％和1.9％（CCAE），6％和2.2％（OPTUM）和4.6％和13.1％（MDCR）。这些模型在所有3个数据库中一致地执行，AUC分别从.69到.77和.68到.73分别为1-和3年预测。预测精度低于AF（AUC：.82）患者乍得2评价的初始工作，但与随后的乍得2（.60-.80）和CHA2DS2-VASC性能的后续荟萃分析一致（.64-.79 ）。结论：尽管现有的预测缺血性卒中和TIA患者的患者可以应用于没有足迹的患者，但有可比的预测准确性，证据表明这些模型的表现有所改善。 （c）2017作者。 elsevier公司发布

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