Investigation Of Stroke Risk Assessment Methods For Non-valvular Atrial Fibrillation Patients

Objectives To explore the stroke risk factors in patients with non-valvular atrial fibrillation. Assessment a New Score establish the stroke risk of atrial fibrillation.Compare CHA2DS2-VASc, CHADS2 and New Score on assessing the risk of ischemic stroke in patients and looking for a more suitable method for them.Methods The clinical data of 1216 patients with NVAF(non-valvular atrial fibrillation)who had hospitalized in Beijing Chaoyang Hospital Affiliated to Capital Medical University and Meitan General Hospital Affiliated to Hebei United University from January 2012 to December,were analyzed in this same group cohort, Collected information. The occurrences of cerebral infarction within an average follow-up of(27±5) months were observed. Using χ2test, wilcoxon rank sum test(non-parametric test method) analysis of stroke risk factors. Using multivariate logistic regression analysis(Enter method) analysis the statistically significant parameters to calculate the size of the model effects(OR), format a new stroke risk score model(New Score). 1216 patients were evaluated by CHADS2 scale, CHA2DS2-VASc scale and New Score. Using the ROC(Receiver Operating Characteristic) curve analysis and comparison the Evaluation effects of CHA2DS2-VASc, CHADS2 and New Score on risk of NVAF patients with Secondary cerebral infarction, and record two scoring systems, 95% confidence interval, P value,sensitivity, specificity value.Results Compare the secondary cerebral infarction group and no secondary cerebral infarction group, The results show that there was a significant difference in age, AF type,Hyperlipidemia,Coronary heart disease, Hypertension, Diabetes, Previous stroke,Myocardial infarction,Vascular disease, NT-pro BNP, ALT, CRP and D-dimer,(P<0.05).Using binary logistic regression analysis the significant differences factors, the results show that stroke risk independently associated with hyperlipidemia, SBP> 160 mm Hg,diabetes, previous infarction and vascular disease,(P <0.05, OR> 1), then establish the New Score score based on the value of each factor OR. Using roc curve compare the ability to predict stroke in NVAF with CHADS2 score, CHA2DS2-VASc score and New Score score. AUCROC(The Area Under the Receiver Operating Curve) of CHA2DS2-VASc, CHADS2 and New Score were 0.877(0.855-0.900), 0.842(0.817 ~ 0.866) and0.850(0.827 ~ 0.873), CHADS2’s Youden index was 0.591, the sensitivity index was0.85, the specificity index was 0.741, the negative predictive value of the false positive rate was 0.259; CHA2DS2-VASc’s Youden index was 0.54, the sensitivity index was 0.88,the specificity index was 0.66, the negative predictive value of the false positive rate was0.34; New Score’s Youden index was 0.381, the sensitivity index was 0.823, the specificity index was 0.958, the negative predictive value of the false positive rate was0.042.Conclusions Hyperlipidemia, SBP>160mm Hg may be new AF-related stroke risk factors. It does not increase the risk of stroke in patients with NVAF that a history of heart failure, age and gender. CHADS2 can more accurately predict ischemic strokes than New Score than CHA2DS2-VASc, CHADS2 score may be the most effectively score which predict the risk of NVAF patients with secondary cerebral infarction. CHA2DS2-VASc score in our country to promote still cautious.