Related Factors Analysis Of Stroke In Patients With Non-valvar Atrial Fibrillation Based Hospital Cases

Background:Atrial fibrillation (AF) is the most common arrhythmia, which is very easily lead to thromboembolic events including the most serious event stroke. Embolism of cardiac origin accounts for about 20% in ischemic stroke. The non-valvular atrial fibrillation increase the risk of stroke about 5-6 times. Except for the risk factors of stroke in patients with AF we have known, such as the left atrial volume, body mass index(BMI), anti-arrhythmic drugs, drugs improving cardiac electrical remodeling (ACEI\ARB) and catheter radiofrequency ablation (pulmonary vein isol-ation) on the impact of stroke are still unclear. Furthermore, in clinical practice, the status of the comprehensive treatment, risk and effect of AF, have not been fully evaluated at present. In addition, the relationship between application of the warfarin and stroke, mortality, which between AF with stroke and mortality in the patients who are in hospital,there are still no large-scale research.Objective:By analyzing general state of health (including sex, BMI), heart disease and the complication, heart ultrasound and warfarin and anti-arrhythmic drugs of the patients with AF in hospital, to pick the risk factors of stroke and evaluate the different treatment strategies on the impact of stroke incidence and mortality with AF. And provide evidence for prevention and clinical management of stroke.Methods:1207 patients who were diagnosed AF in our hospital from January 2006 to January 2009 were enrolled. Retrospective analysis the general state of health (including sex, BMI, type of AF, blood pressure, lipids, etc.),the heart disease-related complications (hypertension, diabetes, coronary heart disease, heart failure, cardiomyopathy, pulmonary heart disease, hyperthyroidism), thrombotic disease and other relevant indicatrix and cardiac ultrasound(left atrial diameter, left ventricular function), antithrombotic drugs(aspirin and warfarin), antiarrhythmic drugs (propa-fenone, amiodarone) and catheter radiofrequency ablation (pulmonary vein isolation) of patients with AF.We also evaluate all the treatments on the impact of the incidence of stroke and situation of the clinical treatment in patients.Results:In all the 1207 patients with AF,198 cases were stroke patients (16.4%), among these 107 cases were male (54.0%); non-stroke were 1009 cases (83.6%), among these 637 cases were male (63.1%). Except for the known stroke risk factors, such as age, hypertension, diabetes, heart failure, thrombotic disease and unused warfarin, factors such as women, large left atrium, obesity, hyperlipidemia (triglycerides, cholesterol), unuse anti-arrhythmia agents were all related with stroke.However, further multivariate Logistic regression analysis showed that: In addition to age (P<0.001), hypertension (P= 0.037), diabetes (P= 0.002),heart failure(P=0.027), the left atrial diameter increased (p= 0.028), obesity (P<0.001) were also independent risk factors for stroke with atrial fibrillation; In the aspect of drug application, warfarin (P= 0.001, OR= 0.659,95%CI=0.517-0.840) would help to reduce incidence of stroke with AF.107 patients with AF accepted the treatment of pulmonary vein isolation, of whom 3 generated stroke and the stroke incidence rate was 2.8%, compared with the treatment of non-pulmonary vein isolation in patients the stroke incidence significantly reduced (2.8%vs.17.7%, P=0.037). Among all the 1207 patients with AF,234 cases used warfarin (19.4%), of whom 37 cases died (3.1%), who were stroke patients,3 cases used warfarin; 973 patients didn't use warfarin, of whom 34 died (1.3% vs.3.5%, P=0.021). Prospective 10-year survival rate in patients AF without stroke was 91.8%, and that in stroke patients with AF was 71.2%.Of all the patients with AF, prospective 10-year survival rate in patients who used warfarin was 87.3%,while that in patients unused warfarin was 78.9%. In the stroke patients with AF, the prospective 10-year survival rate who used warfarin was 76.8%,while that in patients who unused warfarin was only 62.4%.Conclusion:In addition to age, hypertension, diabetes, heart failure, the increased left atrial diameter, obesity are also independent risk factors for stroke patients with AF. While using warfarin can reduce the incidence of stroke with AF. Treatment of pulmonary vein isolation also reduce the incidence of stroke. The use of warfarin effectively reduce incidence and mortality of stroke.