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CHADS(2) and CHA(2)DS(2)-VASc score to assess risk of stroke and death in patients paced for sick sinus syndrome
OBJECTIVE: The risk of stroke in patients with atrial fibrillation (AF) can be assessed by use of the CHADS(2) and the CHA(2)DS(2)-VASc score system. We hypothesised that these risk scores and their individual components could also be applied to patients paced for sick sinus syndrome (SSS) to evalua...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2013
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3664372/ https://www.ncbi.nlm.nih.gov/pubmed/23539553 http://dx.doi.org/10.1136/heartjnl-2013-303695 |
Sumario: | OBJECTIVE: The risk of stroke in patients with atrial fibrillation (AF) can be assessed by use of the CHADS(2) and the CHA(2)DS(2)-VASc score system. We hypothesised that these risk scores and their individual components could also be applied to patients paced for sick sinus syndrome (SSS) to evaluate risk of stroke and death. DESIGN: Prospective cohort study. SETTINGS: All Danish pacemaker centres and selected centres in the UK and Canada. PATIENTS: Risk factors were recorded prior to pacemaker implantation in 1415 patients with SSS participating in the Danish Multicenter Randomized Trial on Single Lead Atrial Pacing versus Dual Chamber Pacing in Sick Sinus Syndrome (Danpace) trial. Development of stroke was assessed at follow-up visits and by evaluation of patient charts. Mortality was assessed from the civil registration system. INTERVENTIONS: Patients were randomised to AAIR (N=707) or DDDR pacing (N=708). MAIN OUTCOME MEASURES: Stroke and death during follow-up. RESULTS: Mean follow-up was 4.3±2.5 years. In the AAIR group 6.9% patients developed stroke versus 6.1% in the DDDR group (NS). There was a significant association between CHADS(2) score and the development of stroke (HR 1.41; 95% CI 1.22 to 1.64, p<0.001). CHA(2)DS(2)-VASc score was also significantly associated with stroke (HR 1.25; CI 1.12 to 1.40, p<0.001). CHADS(2) score (HR 1.46; CI 1.36 to 1.56, p<0.001) and CHA(2)DS(2)-VASc score (HR 1.39; CI 1.31 to 1.46, p<0.001) were associated with mortality. Results were still significant after adjusting for AF and anticoagulation therapy. CONCLUSIONS: CHADS(2) and CHA(2)DS(2)-VASc score are associated with increased risk of stroke and death in patients paced for SSS irrespective of the presence of AF. |
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