The Risk Factor Analysis For Stroke In Non-valvular Atrial Fibrillation Patients With Low-intermediate Risk CHADS2Score

BackgroundAlong with the social changes, aging and various factors of arrhythmia, especially non valvular atrial fibrillation (NVAF) incidence increased year by year and NVAF associated stroke become a heavy burden to society. How to identify high-risk patients with atrial fibrillation early and perform early intervention has become the focus of clinical practice. In2010, the European guidelines for management of atrial fibrillation published, the CHADS2and CHA2DS2-VASc score sytem of incorporated forecasting model was used to stratify risk of stroke in patients with atrial fibrillation. CHADS2scoring system is easy to use and now widely spreaded. But in patients with low-intermediate risk identification of stroke, CHADS2has limitations compared with CHA2DS2-VASc score system, CHA2DS2-VASc score system included other clinical and laboratory risk factors of stroke and further increased the risk of resolution. But because of the cost increasing and its inconvenience, its use is limited. Stroke risk stratification value is not yet verified on CHADS2score in Chinese population. With the stroke prevention effect is better and the new oral anticoagulants appeared which with lower risk of bleeding complications, it is necessary to modify and verify the existing CHADS2score.ObjectiveTo investigate the risk factors for stroke in non-valvular atrial fibrillation (NVAF) patients with low-intermediate risk CHADS2score.MethodsA total of98NVAF with stroke and53NVAF without stroke patients in our hospital from2009to2012were retrospectively analyzed. The CHADS2and CHA2DS2-VASc scores were calculated. The patients were divided into two groups as stroke patients with NVAF and CHADS2(0-2) [NVAF+stroke+CHADS2(0-2)], n=58and patients with NVAF without stroke(control group), n=53.The related risk factors for stroke were investigated and compared between two groups.ResultsThe patients in NVAF+stroke+CHADS2(0-2) group presented higher levels of plasma total cholesterol, higher level of low density lipoprotein-cholesterol(LDL-c) and lipoprotein(a)[Lp(a)], higher levelof left ventricular ejection (LVEF). The patients in NVAF+stroke+CHADS2(0-2)group presented lower heart rate(HR), higher rate of smoking history, coronary heart disease and heart failure(HF), lower levels of plasma alanine aminotransferase (ALT), creatinine (Cr) compared with the control group, P<0.05respectively. Multivariate logistic regression analysis indicated that the high total cholesterol and HR<80bpm were closely related to stroke with low-intermediate CHADS2score.ConclusionsThe total cholesterol and HR<80bpm were the independent risk factors for stroke in NVAF patients with low-intermediate CHADS2risk score. The CHA2DS2-VASc score might have a great impact in cardioembolic stroke prevention not only by improving risk stratification but also by increasing the number of patients with AF in whom anticoagulation is appropriately recommended.