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Korean J Med > Volume 88(6); 2015 > Article
The Korean Journal of Medicine 2015;88(6): 672-679.
발작성 심방 세동에서 지속성 심방 세동으로 진행 및 예후 예측인자
김지은, 이기홍, 이승헌, 박혁진, 김현국, 김성수, 정해창, 조재영, 박근호, 심두선, 윤현주, 윤남식, 박형욱, 김계훈, 홍영준, 김주한, 안영근, 정명호, 조정관, 박종춘
전남대학교 의과대학 전남대학교병원 내과
Predictors of Progression and Prognosis of Paroxysmal Atrial Fibrillation
Ji Eun Kim, Ki Hong Lee, Seunghun Lee, Hyukjin Park, Hyun Kuk Kim, Sung Soo Kim, Hae Chang Jeong, Jae Yeong Cho, Keun-Ho Park, Doo Sun Sim, Hyun Joo Yoon, Nam Sik Yoon, Hyung Wook Park, Kye Hun Kim, Young Joon Hong, Ju Han Kim, Youngkeun Ahn, Myung Ho Jeong, Jeong Gwan Cho, Jong Chun Park
Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
Corresponding Author: Hyung Wook Park ,Tel: +82-62-220-6572, Fax: +82-62-223-3105, Email: mdhwp@chol.com
Received: August 21, 2014;   Revised: October 13, 2014;   Accepted: November 8, 2014.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Significant numbers of patients with paroxysmal atrial fibrillation (AF) proceed to persistent AF and have poor clinical outcomes despite the use of antiarrhythmic agents or direct-current cardioversion. We compared the CHADS2, CHA2DS2-VASc, and HATCH scoring systems to predict AF progression and prognosis and identify the most useful scoring system in Korea.
A total of 559 consecutive patients with paroxysmal symptomatic AF were analyzed. The progression of AF and clinical outcomes were determined after at least 1 year of follow-up. Clinical outcomes were defined as the composite of death, hospitalization due to heart failure, and new-onset stroke. Each score was calculated, and its predictive accuracy for AF progression and prognosis was compared.
A total of 147 patients with paroxysmal AF (26.3%) proceeded to persistent AF. The HATCH score (area under the curve [AUC], 0.601; p < 0.001) was the most powerful scoring system for the prediction of AF progression, although the CHADS2 (AUC, 0.565) and CHA2DS2-VASc (AUC, 0.558) were also useful. The CHA2DS2-VASc (AUC, 0.734; p < 0.001) was the most powerful scoring system for the prediction of clinical outcomes with a more significant linear correlation (0: 3.3% vs. 1: 6.3% vs. 2: 15.4% vs. 3: 20.7% vs. 4: 18.0% vs. 5: 53.6% vs. ≥ 6: 55.6%, linear p < 0.001) than the CHADS2 (AUC, 0.720) and HATCH scoring systems (AUC, 0.723).
Although the CHADS2, CHA2DS2-VASc, and HATCH scoring systems were useful predictors of progression from paroxysmal to persistent AF, the CHA2DS2-VASc score was the most useful and accurate for the prediction of clinical outcomes.
Keywords: Atrial fibrillation; Paroxysmal; Progression; Prognosis
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