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Shing-jong Lin - One of the best experts on this subject based on the ideXlab platform.
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usefulness of the CHADS2 Score for prognostic stratification in patients with coronary artery disease having coronary artery bypass grafting
2017Co-Authors: Po-hsun Huang, Jaw-wen Chen, Shing-jong Lin, Chinchou Huang, Tzengji ChenAbstract:Current risk model for long-term survival prediction in isolated coronary artery bypass graft surgery is complicated, whereas a simple useful model is still lacking. We aim to investigate if CHADS2 Score could predict long-term outcome for patients after coronary artery bypass graft surgery. From 2000 to 2007, we identified a study cohort consisting of patients who underwent coronary bypass surgery in the Taiwan National Health Insurance Research Database. After operation, all cases were followed to track the incidence of major adverse cardiovascular events and overall mortality. During a mean 5.1-year follow-up, 638 patients experienced major cardiovascular events. Six hundred twenty-five patients passed away at the end of follow-up, whereas 204 died of cardiovascular cause. Subjects with higher CHADS2 Scores had significantly higher 10-year overall mortality and cardiovascular death, as well as the incidence of major adverse cardiovascular events. After adjustment with co-morbid condition and prescribed medications, CHADS2 was independently associated with increased risks of all-cause mortality (hazard ratio 1.36, 95% CI 1.29 to 1.44) and cardiovascular mortality (hazard ratio 1.37, 95% CI 1.24 to 1.52). In conclusion, CHADS2 Score provides a quick and useful tool in predicting long-term outcome for patients after coronary artery bypass surgery.
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usefulness of the CHADS2 Score for prognostic stratification of patients with acute myocardial infarction
2014Co-Authors: Shao-sung Huang, Wan-leong Chan, Po-hsun Huang, Jaw-wen Chen, Yinghwa Chen, Shing-jong LinAbstract:The Thrombolysis In Myocardial Infarction (TIMI) Score and Global Registry of Acute Coronary Events (GRACE) Score have been validated as predictors of major adverse cardiovascular events (MACE) in patients with acute myocardial infarction (AMI). This study was undertaken to determine whether the CHADS 2 Score had good accuracy for predicting clinical outcome in patients with AMI and to compare the discriminatory performance of the 3 risk Scores (RSs). We calculated the TIMI RS, GRACE RS, and CHADS 2 Score for 747 consecutive patients with AMI. The study end point was the combined occurrence of MACE, including death, nonfatal myocardial infarction, and ischemic stroke. All patients were followed up for at least 3 years or until the occurrence of a major event. The area under the receiver operating characteristic curve was used to evaluate the predictive ability of each Score at different time points. Higher CHADS 2 Scores were associated with adverse outcome at discharge and 1-year and 3-year follow-ups (chi-square test for linear trend, p 2 Score and GRACE RS demonstrated better discrimination than TIMI RS in predicting 1-year and 3-year MACE (p 2 Score was an independent predictor of future MACE in patients with AMI (hazard ratio 1.349, 95% confidence interval 1.196 to 1.522). In conclusion, the CHADS 2 Score provides potentially valuable prognostic information on clinical outcome when applied to patients with AMI.
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Association between CHADS2 Score and the preventive effect of statin therapy on new-onset atrial fibrillation in patients with acute myocardial infarction.
2013Co-Authors: Shao-sung Huang, Wan-leong Chan, Hsin-bang Leu, Po-hsun Huang, Jaw-wen Chen, Shing-jong LinAbstract:Objectives New-onset atrial fibrillation (AF) commonly occurs in patients with acute myocardial infarction (AMI). Data regarding the value of the CHADS2 Score in patients hospitalized for AMI is limited. This study aimed to determine whether the CHADS2 Score is associated with new-onset AF and if it can help identify the patients who will benefit most from statin use for the prevention of arrhythmia after AMI.
Yoshio Kobayashi - One of the best experts on this subject based on the ideXlab platform.
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the CHADS2 Score is a useful predictor of coronary arteriosclerosis on 320 slice ct and may correlate with prognosis in subjects with atrial fibrillation
2015Co-Authors: Masae Uehara, Nobusada Funabashi, Hiroyuki Takaoka, Koya Ozawa, Yoshio KobayashiAbstract:Abstract Purpose In evaluating coronary arteries by 64–256 slice CT, atrial fibrillation (AF) is usually an exclusion criterion. We used CHADS2 Score to predict coronary arteriosclerosis estimated by 320-slice CT and prognosis in AF subjects. Methods A total of 183 consecutive subjects (148 male; 64.1±11.1years, 97 hypertension, 60 hyperlipidemia, 21 diabetes mellitus, 76 smoking habits, body mass index 23.4±3.5) who were diagnosed previously as chronic (N=104) or paroxysmal AF (N=79), and who underwent electrocardiogram-gated 320-slice CT were enrolled. The composite end point of cardiac death or sudden death was assessed. Results A total of 183 AF subjects were divided into 3 groups: CHADS2 Scores of 0 (N=53), 1 (N=57) and ≥2 (N=73). Frequency of the presence of calcified plaque, non-calcified plaque, mixed plaque, any plaque, and >50% stenosis and Agatston calcium Score was significantly lower in CHADS2 Score 0 group compared with Score 1 or Score≥2 groups. In logistic-regression models for prediction of calcified plaque, or any plaque on CT, the odds ratios of CHADS2 Score≥2 group to CHADS2 Score 0 or 1 group were 2.03 and 2.12, respectively (both P 2 Score≥2 than those with CHADS2 Score 0 (P=0.049) in Kaplan–Meier survival analysis. Conclusions The CHADS2 Score is a useful predictor of coronary arteriosclerosis on CT and may correlate with prognosis in AF subjects. Subjects with high CHADS2 Score should be examined for coronary arteriosclerosis in addition to cerebral infarction.
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cha2ds2 vasc Score is a useful predictor of not prognosis but coronary arteriosclerosis in chronic atrial fibrillation compared with CHADS2 Score a two center study of 320 slice ct part 2
2014Co-Authors: Masae Uehara, Nobusada Funabashi, Hiroyuki Takaoka, Koya Ozawa, Shunichi Kushida, Junji Kanda, Yoshihide Fujimoto, Yoshio KobayashiAbstract:Abstract Background The aim of this study is to predict the risk of coronary-arteriosclerosis and prognosis in subjects with chronic-atrial-fibrillation (CAF) using the CHADS2 and CHA2DS2-VASc Scores by 320-slice-CT and invasive-coronary-angiography (ICA) in a two-center-study. Methods 53 CAF subjects who underwent 320-slice-CT and ICA within 6-months (43 male; 69±9years; CHADS2 Score 2.2±1.3; CHA2DS2-VASc Score 3.5±1.6) in the two-institutes were analyzed. CT and ICA data were transferred to the analysis-center and were analyzed by cardiologists. Results Agatston-calcium-Score and frequencies of the presence of various-kinds of plaques and >50% and >75% coronary artery stenosis were significantly higher in the subjects with CHA2DS2-VASc Score ≥3 compared with those with Score 50% and >75% coronary artery stenosis evaluated by 320-slice CT between the subjects with CHADS2 Score ≥2 and 50% coronary artery stenosis by ICA was significantly higher in the subjects with CHA2DS2-VASc Score ≥3 compared with those with Score 50% and >75% coronary artery stenosis by ICA between the subjects with CHADS2 Score ≥2 and Conclusions The CHA2DS2-VASc Score is a useful predictor of not prognosis but coronary-arteriosclerosis in subjects with CAF compared with CHADS2 Score in this two-center-study.
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abstract 12893 left atrial appendage ct contrast defects correlate with CHADS2 Score and is a prognostic indicator for embolism in subjects with atrial fibrillation or flutter
2014Co-Authors: Nobusada Funabashi, Masae Uehara, Hiroyuki Takaoka, Koya Ozawa, Yoshio KobayashiAbstract:Introduction: Early phase CT contrast defects in the left atriium (LA) and left atrial appendage (LAA) are often observed in atrial fibrillation (AF) or atrial flutter (AFL) despite absence of thrombi. However their clinical significance is unclear. Hypothesis: In order to investigate this correlation we compared CT, transesophageal echocardiology (TEE), CHADS2 Score, and occurrence of embolism (including cerebral infarction). Methods: A total of 32 AF or AFL subjects who underwent CT and TEE within 3 months were enrolled. 5 subjects with LAA thrombi by TEE were excluded. A total of 27 subjects were retrospectively analyzed (persistent AFL 10, persistent AF 9, chronic AF 3, paroxysmal AF 3, permanent atrial standstill 2, 22 male, 61±11 years, occurrence of embolism 26%, median CHADS2 Score 1). We measured velocity in the LAA by TEE. We also measured CT attenuations in the LAA and LA, and calculated LAA/LA ratios. Results: CT LAA/LA ratios were significantly lower in subjects with embolism than without (0.44±0.30 vs 0.74±0.24). CT LAA/LA ratios were smaller when CHADS2 Score was ≥2 (0.57±0.31 vs 0.75±0.24). CT LAA/LA ratios correlated with TEE LAA velocity (R=0.44). According to receiver operating characteristic (ROC) curves, at a best cutoff of 24.3m/sec (TEE LAA velocity), sensitivity and specificity for occurrence of embolism were 70% and 86%, respectively (Area under the curve (AUC) 0.69). Another ROC curve, at a best cutoff of 0.41 (CT LAA/LA ratio), produced a sensitivity and specificity for occurrence of embolism of 90% and 71%, respectively (AUC 0.78). In logistic regression models using LA diameter, left ventricular ejection fraction, presence of moderate to severe mitral valve stenosis or regurgitation measured by TEE, the odds ratio for CT LAA/LA ratios was 0.017 (P=0.043) for prediction of embolism. Conclusion: CT LAA/LA ratio correlates with TEE LA velocity and is a prognostic indicator for the occurrence of embolism in AF or AFL subjects without LAA thrombosis.
Gregory Y H Lip - One of the best experts on this subject based on the ideXlab platform.
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risk profiles and antithrombotic treatment of patients newly diagnosed with atrial fibrillation at risk of stroke perspectives from the international observational prospective garfield registry
2013Co-Authors: Ajay K Kakkar, Gregory Y H Lip, Shinya Goto, Iris Mueller, Jeanpierre Bassand, David Fitzmaurice, Samuel Z Goldhaber, Sylvia Haas, Werner Hacke, L G MantovaniAbstract:Background: Limited data are available on the characteristics, clinical management, and outcomes of patients with atrial fibrillation at risk of stroke, from a worldwide perspective. The aim of this study was to describe the baseline characteristics and initial therapeutic management of patients with non-valvular atrial fibrillation across the spectrum of sites at which these patients are treated. Methods and Findings: The Global Anticoagulant Registry in the FIELD (GARFIELD) is an observational study of patients newly diagnosed with non-valvular atrial fibrillation. Enrollment into Cohort 1 (of 5) took place between December 2009 and October 2011 at 540 sites in 19 countries in Europe, Asia-Pacific, Central/South America, and Canada. Investigator sites are representative of the distribution of atrial fibrillation care settings in each country. Cohort 1 comprised 10,614 adults ($18 years) diagnosed with non-valvular atrial fibrillation within the previous 6 weeks, with $1 investigator-defined stroke risk factor (not limited to those in existing risk-stratification schemes), and regardless of therapy. Data collected at baseline included demographics, medical history, care setting, nature of atrial fibrillation, and treatments initiated at diagnosis. The mean (SD) age of the population was 70.2 (11.2) years; 43.2% were women. Mean6SD CHADS2 Score was 1.961.2, and 57.2% had a Score $2. Mean CHA2DS2-VASc Score was 3.261.6, and 8,957 (84.4%) had a Score $2. Overall, 38.0% of patients with a CHADS2 Score $2 did not receive anticoagulant therapy, whereas 42.5% of those at low risk (Score 0) received anticoagulant therapy. Conclusions: These contemporary observational worldwide data on non-valvular atrial fibrillation, collected at the end of the vitamin K antagonist-only era, indicate that these drugs are frequently not being used according to stroke risk Scores and guidelines, with overuse in patients at low risk and underuse in those at high risk of stroke.
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the cha2ds2 vasc Score identifies those patients with atrial fibrillation and a CHADS2 Score of 1 who are unlikely to benefit from oral anticoagulant therapy
2013Co-Authors: Michiel Coppens, Gregory Y H Lip, John W Eikelboom, Robert G Hart, Salim Yusuf, Paul Dorian, Olga Shestakovska, Stuart J ConnollyAbstract:Aims The CHA2DS2-VASc Score is a modification of the CHADS2 Score that aims to improve stroke risk prediction in patients with atrial fibrillation (AF) by adding three risk factors: age 65–74, female sex, and history of vascular disease. Whereas previous evaluations of the CHA2DS2-VASc Score included all AF patients, the aim of this analysis was to evaluate its discriminative ability only in those patients for whom recommendations on antithrombotic treatment are uncertain (i.e. CHADS2 Score of 1). Methods and results We selected all patients with a CHADS2 Score of 1 from the AVERROES and ACTIVE trials who were treated with acetylsalicylic acid with or without clopidogrel and calculated the incidences of ischaemic or unspecified stroke or systemic embolus (SSE) according to their CHA2DS2-VASc Score. Of 4670 patients with a baseline CHADS2 Score of 1, 26% had a CHA2DS2-VASc Score of 1 and 74% had a Score of ≥2. After 11 414 patient-years of follow-up, the annual incidence of SSE was 0.9% (95% CI: 0.6–1.3) and 2.1% (95% CI: 1.8–2.5) for patients with a CHA2DS2-VASc Score of 1 and ≥2, respectively. The c-statistic of the CHA2DS2-VASc Score was 0.587 (95% CI: 0.550–0.624). Age 65 to <75 years was the strongest of the three new risk factors in the CHA2DS2-VASc Score. Conclusion The CHA2DS2-VASc Score reclassifies 26% of patients with a CHADS2 Score of 1 to a low annual risk of SSE of 1%. This risk seems low enough to consider withholding anticoagulant treatment.
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the value of the cha2ds2 vasc Score for refining stroke risk stratification in patients with atrial fibrillation with a CHADS2 Score 0 1 a nationwide cohort study
2012Co-Authors: Jonas Bjerring Olesen, Christian Torppedersen, Morten Lock Hansen, Gregory Y H LipAbstract:North American and European guidelines on atrial fibrillation (AF) are conflicting regarding the classification of patients at low/intermediate risk of stroke. We aimed to investigate if the CHA2DS2-VASc Score improved risk stratification of AF patients with a CHADS2 Score of 0–1. Using individual-level-linkage of nationwide Danish registries 1997–2008, we identified patients discharged with AF having a CHADS2 Score of 0–1 and not treated with vitamin K antagonist or heparin. In patients with a CHADS2 Score of 0, 1, and 0–1, rates of stroke/ thromboembolism were determined according to CHA2DS2-VASc Score, and the risk associated with increasing CHA2DS2-VASc Score was estimated in Cox regression models adjusted for year of inclusion and antiplatelet therapy. The value of adding the extra CHA2DS2-VASc risk factors to the CHADS2 Score was evaluated by c-statistics, Net Reclassification Improvement (NRI) and Integrated Discrimination Improvement (IDI). We included 47,576 patients with a CHADS2 Score of 0–1, from these 7,536 (15.8%) were CHA2DS2-VASc Score=0, 10,062 (21.2%) were CHA2DS2-VASc Score=1, 14,310 (30.1%) were CHA2DS2-VASc Score=2, 14,188 (29.8%) were CHA2DS2-VASc Score=3, and 1,480 (3.1%) were CHA2DS2-VASc Score=4. Of the cohort with a CHADS2 Score of 0–1, the stroke/thromboembolism rate per 100 person-years increased with increasing CHA2DS2-VASc Score (95% confidence interval): 0.84 (0.65–1.08), 1.79 (1.53–2.09), 3.67 (3.34–4.03), 5.75 (5.33–6.21), and 8.18 (6.68–10.02) at one year follow-up with CHA2DS2-VASc Scores of 0, 1, 2, 3, and 4, respectively. Patients with a CHADS2 Score=0 were not all ‘low risk’, with one-year event rates ranging from 0.84 (CHA2DS2-VASc Score=0) to 3.2 (CHA2DS2-VASc Score=3). Results from Cox regression analyses, NRI, and IDI confirmed the improved predictive ability of the CHA2DS2-VASc Score in the AF patients who have a CHADS2 Score of 0–1. In conclusion, the CHA2DS2-VASc provides critical information on risk of stroke in AF patients with a CHADS2 Score of 0–1 that can aid a decision of using anticoagulation. Even in patients categorised as ‘low risk’ using a CHADS2 Score=0, the CHA2DS2-VASc Score significantly improved the predictive value of the CHADS2 Score alone and a CHA2DS2-VASc Score=0 could clearly identify ‘truly low risk’ subjects. Use of the CHA2DS2-VASc Score would significantly improve classification of AF patients at low and intermediate risk of stroke, compared to the commonly used CHADS2 Score.
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use of the CHADS2 and cha2ds2 vasc Score in japanese patients with atrial fibrillation a sub analysis of the japan thrombosis registry for atrial fibrillation coronary or cerebrovascular events j trace
2012Co-Authors: Eri Toda, Gregory Y H Lip, Shinichiro Uchiyama, Hideki Origasa, Kazyuyuki Shimada, Hiroyuki Kobayashi, Akio Kawamura, Kazuo Kitagawa, Takehiko Nagao, Yasuo IkedaAbstract:Risk stratification of the patients with atrial fibrillation (AF), especially in low risk patients, is important for selecting patients for oral anticoagulant therapy. We investigated the use of the new CHA2DS2-VASc Score in comparison with older CHADS2 Score in Japanese patients with AF using a
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abstract 12001 afcas a prospective multicenter registry of patients with atrial fibrillation undergoing coronary artery stenting comparison of CHADS2 with cha2ds2 vasc Score
2011Co-Authors: Axel Schlitt, Gregory Y H Lip, Andrea Rubboli, Heli Lathela, Jose Valencia, Pasi P Karjalainen, Michael A Weber, Mika Laine, Paulus Kirchhof, Matti NiemelaAbstract:Background Current European guidelines on the management of patients with atrial fibrillation (AF) recommend the use of the new CHA2DS2-VASc Score to complement the simple CHADS2 Score to assist st...
Luigi Di Biase - One of the best experts on this subject based on the ideXlab platform.
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periprocedural stroke and bleeding complications in patients undergoing catheter ablation of atrial fibrillation with different anticoagulation management results from the role of coumadin in preventing thromboembolism in atrial fibrillation af patients undergoing catheter ablation compare randomized trial
2014Co-Authors: Luigi Di Biase, Pasquale Santangeli, Prasant Mohanty, Rodney Horton, Javier Sanchez, Sakis Themistoclakis, David J Burkhardt, Joseph G Gallinghouse, Antonio Rossillo, Dhanunjaya LakkireddyAbstract:Background—Periprocedural thromboembolic and hemorrhagic events are worrisome complications of catheter ablation for atrial fibrillation (AF). The periprocedural anticoagulation management could play a role in the incidence of these complications. Although ablation procedures performed without warfarin discontinuation seem to be associated with lower thromboembolic risk, no randomized study exists. Methods and Results—This was a prospective, open-label, randomized, parallel-group, multicenter study assessing the role of continuous warfarin therapy in preventing periprocedural thromboembolic and hemorrhagic events after radiofrequency catheter ablation. Patients with CHADS2 Score ≥1 were included. Patients were randomly assigned in a 1:1 ratio to the off-warfarin or on-warfarin arm. The incidence of thromboembolic events in the 48 hours after ablation was the primary end point of the study. The study enrolled 1584 patients: 790 assigned to discontinue warfarin (group 1) and 794 assigned to continuous warfa...
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does the left atrial appendage morphology correlate with the risk of stroke in patients with atrial fibrillation results from a multicenter study
2012Co-Authors: Luigi Di Biase, Pasquale Santangeli, Matteo Anselmino, Prasant Mohanty, Ilaria Salvetti, Sebastiano Gili, Rodney Horton, Javier Sanchez, Rong Bai, Sanghamitra MohantyAbstract:Objectives This study investigated the left atrial appendage (LAA) by computed tomography (CT) and magnetic resonance imaging (MRI) to categorize different LAA morphologies and to correlate the morphology with the history of stroke/transient ischemic attack (TIA). Background LAA represents one of the major sources of cardiac thrombus formation responsible for TIA/stroke in patients with atrial fibrillation (AF). Methods We studied 932 patients with drug-refractory AF who were planning to undergo catheter ablation. All patients underwent cardiac CT or MRI of the LAA and were screened for history of TIA/stroke. Four different morphologies were used to categorize LAA: Cactus, Chicken Wing, Windsock, and Cauliflower. Results CT scans of 499 patients and MRI scans of 433 patients were analyzed (age 59 ± 10 years, 79% were male, and 14% had CHADS2 [Congestive heart failure, Hypertension, Age >75, Diabetes mellitus, and prior Stroke or transient ischemic attack] Score ≥2). The distribution of different LAA morphologies was Cactus (278 [30%]), Chicken Wing (451 [48%]), Windsock (179 [19%]), and Cauliflower (24 [3%]). Of the 932 patients, 78 (8%) had a history of ischemic stroke or TIA. The prevalence of pre-procedure stroke/TIA in Cactus, Chicken Wing, Windsock, and Cauliflower morphologies was 12%, 4%, 10%, and 18%, respectively (p = 0.003). After controlling for CHADS2 Score, gender, and AF types in a multivariable logistic model, Chicken Wing morphology was found to be 79% less likely to have a stroke/TIA history (odd ratio: 0.21, 95% confidence interval: 0.05 to 0.91, p = 0.036). In a separate multivariate model, we entered Chicken Wing as the reference group and assessed the likelihood of stroke in other groups in relation to reference. Compared with Chicken Wing, Cactus was 4.08 times (p = 0.046), Windsock was 4.5 times (p = 0.038), and Cauliflower was 8.0 times (p = 0.056) more likely to have had a stroke/TIA. Conclusions Patients with Chicken Wing LAA morphology are less likely to have an embolic event even after controlling for comorbidities and CHADS2 Score. If confirmed, these results could have a relevant impact on the anticoagulation management of patients with a low-intermediate risk for stroke/TIA.
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left atrial appendage morphology and risk of stroke in patients with af and CHADS2 Score 0 1 is there an association
2012Co-Authors: Luigi Di Biase, Pasquale Santangeli, Matteo Anselmino, Prasant Mohanty, Ilaria Salvetti, Sebastiano Gili, Rodney Horton, Javier Sanchez, Rong Bai, Sanghamitra MohantyAbstract:In pts with atrial fibrillation (AF) and CHADS2 Score 0-1 the indication for antithrombotic therapy is controversial. We evaluated different LAA morphologies by computed tomography (CT) and by magnetic resonance imaging (MRI) in pts with CHADS2 Score 0-1 and AF to correlate the different
Jaw-wen Chen - One of the best experts on this subject based on the ideXlab platform.
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usefulness of the CHADS2 Score for prognostic stratification in patients with coronary artery disease having coronary artery bypass grafting
2017Co-Authors: Po-hsun Huang, Jaw-wen Chen, Shing-jong Lin, Chinchou Huang, Tzengji ChenAbstract:Current risk model for long-term survival prediction in isolated coronary artery bypass graft surgery is complicated, whereas a simple useful model is still lacking. We aim to investigate if CHADS2 Score could predict long-term outcome for patients after coronary artery bypass graft surgery. From 2000 to 2007, we identified a study cohort consisting of patients who underwent coronary bypass surgery in the Taiwan National Health Insurance Research Database. After operation, all cases were followed to track the incidence of major adverse cardiovascular events and overall mortality. During a mean 5.1-year follow-up, 638 patients experienced major cardiovascular events. Six hundred twenty-five patients passed away at the end of follow-up, whereas 204 died of cardiovascular cause. Subjects with higher CHADS2 Scores had significantly higher 10-year overall mortality and cardiovascular death, as well as the incidence of major adverse cardiovascular events. After adjustment with co-morbid condition and prescribed medications, CHADS2 was independently associated with increased risks of all-cause mortality (hazard ratio 1.36, 95% CI 1.29 to 1.44) and cardiovascular mortality (hazard ratio 1.37, 95% CI 1.24 to 1.52). In conclusion, CHADS2 Score provides a quick and useful tool in predicting long-term outcome for patients after coronary artery bypass surgery.
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usefulness of the CHADS2 Score for determining risk of seizure in patients with atrial fibrillation
2016Co-Authors: Chien Yi Hsu, Hsin-bang Leu, Po-hsun Huang, Tz Heng Chen, Chun Chin Chang, Mu Hong Chen, Jaw-wen ChenAbstract:Atrial fibrillation (AF) secondary to seizure has been described in case reports, but the association between AF and risk of seizure has never been evaluated in longitudinal studies. The objectives of this study were to investigate the role of AF on the risk of development of seizure and the usefulness of CHADS 2 Score for predicting the risk of seizure. Our analyses were conducted using information from a random sample of 1 million subjects enrolled in Taiwan National Health Insurance Research Database. A total of 11,552 subjects aged ≥18 years, comprising 5,776 subjects diagnosed with AF during the study period and 5,776 age and sex-matched subjects without AF were enrolled in our study. During the mean follow-up of 6.7 ± 3.3 years, seizure events occurred in 235 patients. In comparison, the AF group had a higher incidence rate of seizure occurrence (4.17 vs 1.90 per 1,000 person-years). Cox proportional hazard regression model analysis showed that development of AF was independently associated with a higher risk of developing future seizure (adjusted HR 2.30; 95% confidence interval 1.73 to 3.05). In multivariate Cox regression analysis adjusted for potentially confounding variables, a higher CHADS 2 Score was associated with a higher risk of seizure in a dose-dependent manner. AF may cause an ischemic stroke that subsequently leads to seizure, and present study further demonstrates that AF patients are associated with higher rate of subsequent seizure, even after adjusting for stroke. The CHADS 2 Score was found to be a useful scheme for predicting the risk of seizure occurrence.
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usefulness of the CHADS2 Score for prognostic stratification of patients with acute myocardial infarction
2014Co-Authors: Shao-sung Huang, Wan-leong Chan, Po-hsun Huang, Jaw-wen Chen, Yinghwa Chen, Shing-jong LinAbstract:The Thrombolysis In Myocardial Infarction (TIMI) Score and Global Registry of Acute Coronary Events (GRACE) Score have been validated as predictors of major adverse cardiovascular events (MACE) in patients with acute myocardial infarction (AMI). This study was undertaken to determine whether the CHADS 2 Score had good accuracy for predicting clinical outcome in patients with AMI and to compare the discriminatory performance of the 3 risk Scores (RSs). We calculated the TIMI RS, GRACE RS, and CHADS 2 Score for 747 consecutive patients with AMI. The study end point was the combined occurrence of MACE, including death, nonfatal myocardial infarction, and ischemic stroke. All patients were followed up for at least 3 years or until the occurrence of a major event. The area under the receiver operating characteristic curve was used to evaluate the predictive ability of each Score at different time points. Higher CHADS 2 Scores were associated with adverse outcome at discharge and 1-year and 3-year follow-ups (chi-square test for linear trend, p 2 Score and GRACE RS demonstrated better discrimination than TIMI RS in predicting 1-year and 3-year MACE (p 2 Score was an independent predictor of future MACE in patients with AMI (hazard ratio 1.349, 95% confidence interval 1.196 to 1.522). In conclusion, the CHADS 2 Score provides potentially valuable prognostic information on clinical outcome when applied to patients with AMI.
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Association between CHADS2 Score and the preventive effect of statin therapy on new-onset atrial fibrillation in patients with acute myocardial infarction.
2013Co-Authors: Shao-sung Huang, Wan-leong Chan, Hsin-bang Leu, Po-hsun Huang, Jaw-wen Chen, Shing-jong LinAbstract:Objectives New-onset atrial fibrillation (AF) commonly occurs in patients with acute myocardial infarction (AMI). Data regarding the value of the CHADS2 Score in patients hospitalized for AMI is limited. This study aimed to determine whether the CHADS2 Score is associated with new-onset AF and if it can help identify the patients who will benefit most from statin use for the prevention of arrhythmia after AMI.