| BackgroundAtrial fibrillation is a common arrhythmia in clinical practice.With the aging of the population and lifestyle changes,atrial fibrillation is becoming an emerging infectious disease in cardiovascular disease.The risk of atrial fibrillation combined with stroke increased by 4-5 times,the risk of heart failure increased by 3 times,the risk of dementia increased by nearly 1 times,and the risk of all-cause death increased by 40%-90%.Therefore,it is important to assess the risk of cerebral infarction in patients with atrial fibrillation and to give corresponding anticoagulant therapy according to the risk degree.Atherosclerotic cardiovascular disease is still the main cause of death worldwide.The prevention and treatment of coronary heart disease in general to take antiplatelet therapy.In patients with atrial fibrillation,it is commonly used anticoagulant therapy to prevent stroke,when AF patients with coronary heart disease were also treated with anticoagulation and antiplatelet therapy,but the use of antiplatelet and anticoagulant therapy will increase the risk of bleeding.Therefore,in clinical work,it is necessary to select patients with coronary artery disease in patients with atrial fibrillation with the relevant indicators,and then take the different strategies of antithrombotic therapy（anticoagulation and/or antiplatelet therapy）,if necessary,coronary artery revascularization is used.The CHADS2 score and the CHA2DS2-VASc score are a very convenient and practical scoring system for assessing the risk of embolism in patients with non valvular atrial fibrillation.Recent studies have shown that CHADS2 score and CHA2DS2-VASc score can also predict the prognosis of patients with nonvalvular atrial fibrillation,including cerebral atherosclerosis,fatal ischemic heart disease and early neurological impairment.In a study of clinical trials in patients with non valvular atrial fibrillation related stroke,the patients whose CHADS2 score and CHA2DS2-VASc score were higher in have the left ventricular wall motion of left ventricular dysfunction,abnormal motion stage and the recent high incidence of acute myocardial infarction.The CHADS2 score and CHA2DS2-VASc score contain most of the risk factors of atherosclerosis,and these factors is associated with cardiovascular mortality.Therefore,there is a certain correlation between coronary artery disease and CHADS2 score and CHA2DS2-VASc score in patients with atrial fibrillation.Therefore,it is feasible to predict coronary artery disease in patients with atrial fibrillation by using CHADS2 scoring system and CHA2DS2-VASc scoring system,and it has important guiding significance for clinical work.ObjectiveThe purpose of this study was to investigate the correlation between the CHADS2 score and the CHA2DS2-VASc score and the degree of coronary artery disease in patients with atrial fibrillation.MethodA retrospective analysis was made of 242 patients who were hospitalized from January 2015 to January 2017 and these patients were diagnosed with atrial fibrillation.Combined with clinical symptoms,routine 12 lead electrocardiogram and treadmill exercise test,it is suggested that coronary artery disease may be associated with selective coronary angiography.According to the results of coronary angiography these patients were divided into control group（n=70）and coronary artery disease group（n=172）.According to the Gensini score standard coronary artery disease group was divided into mild coronary artery disease group（GS 1-30 points）（n=96）and severe coronary artery disease group（GS=30 points）（n=76）.Statistics of basic clinical data of the three groups:general situation（age,gender,smoking history,family history of coronary artery disease and antithrombus therapy）;complications（congestive heart failure,hypertension,diabetes,history of stroke or TIA,vascular disease）;echocardiographic parameters;relevant laboratory index the CHADS2 score and CHA2DS2-VASc score.Statistical analysis of the difference of indicators between the three groups of patients,and to analyze the correlation between CHADS2 score and CHA2DS2-VASc score and the degree of coronary artery disease in patients with atrial fibrillation.Result1.The scores of CHADS2 and CHA2DS2-VASc scores in the coronary artery disease group were higher than those in the control group.The subgroup analysis showed that the scores of CHADS2 and CHA2DS2-VASc scores in the severe coronary lesions were higher than those in the mild lesion group,and the difference was statistically significant（p<0.05）.2.With the increase of CHADS2 score,the degree of coronary artery disease Gensini score increased,the Pearson correlation analysis showed that there is a positive correlation CHADS2 score and Gensini score（y=1.31+8.73*x,r=0.599,p<0.05）;With the increase of CHA2DS2-VASc score,coronary artery lesions Gensini score also showed an upward trend,the Pearson correlation analysis showed that there is a positive correlation CHA2DS2-VASc score and Gensini score（y=1.22+7.11*x,r=0.624,p<0.05）.3.Multivariate logistic regression analysis showed that higher CHADS2 score and CHA2DS2-VASc score were predictors of coronary artery disease in patients with atrial fibrillation.4.Summary Receiver Operating Characteristic curve was performed and the area under the curve（AUC）was calculated.The area under the curve of the CHADS2score and CHA2DS2-VASc score was plotted.The area under the curve of CHADS2score was 0.747（95%CI:0.654–0.839）and the area under the curve of CHA2DS2-VASc score was 0.790（95%CI:0.709–0.871）,respectively,and the difference was statistically significant（p<0.05）.That is,the CHA2DS2-VASc score was more valuable in predicting the diagnosis of coronary artery disease in patients with atrial fibrillation.Conclusion1.The CHADS2 score and CHA2DS2-VASc score correlate with the degree of coronary artery disease in patients with atrial fibrillation and can be used as a predictor of coronary artery disease in patients with atrial fibrillation.The value of the CHA2DS2-VASc score in predicting coronary artery disease in patients with atrial fibrillation is greater than the CHADS2 score.2.In clinical work,when the CHADS2 score and CHA2DS2-VASc score are high in patients with atrial fibrillation,the risk of coronary artery disease is higher in these patients.Coronary examination（coronary angiography or coronary CT angiography）should be performed at the same time.Early detection of coronary artery disease and appropriate anticoagulant therapy（anticoagulant therapy and/or antiplatelet therapy）,coronary revascularization if necessary,to reduce the incidence of cardiovascular events. |
