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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：中风主要发生在无房颤（AF）的患者中。本研究探讨了无房颤患者缺血性中风和短暂性脑缺血发作（TIA）的风险预测模型。方法：使用三个美国医疗数据库（Truven MarketScan商业索赔和遭遇[CCAE]、医疗保险补充[MDCR]和Optum Clinformatics[Optum]）在2008-2012年的指数期间建立无房颤患者队列。通过将logistic回归拟合到训练数据集，并分别使用完全随访1年或3年的患者评估验证数据集（曲线下面积，AUC）中的预测准确性，检查了两个现有模型（CHADS2和CHA2DS2 VASc）预测中风和TIA的性能。结果：与符合医疗保险条件的人群相比，商业人群更年轻，合并症更少。随访1年和3年期间，缺血性卒中和TIA的发病率分别为.5%和1.9%（CCAE），.6%和2.2%（Optum），以及4.6%和13.1%（MDCR）。这些模型在所有3个数据库中表现一致，1年和3年预测的AUC分别为0.69至0.77和0.68至0.73。预测准确性低于房颤患者CHADS2评估的初始工作（AUC:.82），但与随后对CHADS2（.60-.80）和CHA2DS2 VASc表现（.64-.79）的荟萃分析一致。结论：虽然现有的预测AF患者缺血性卒中和TIA的方案可以应用于无AF的患者，且具有相当的预测准确性，但证据表明，这些模型的性能还有改进的空间。（C） 2017年，作者。爱思唯尔公司出版。

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