Analysis Of Influencing Factors Of Thromboembolic Events In Patients With Low-risk Non-valvular Atrial Fibrillation

BackgroundCHA2DS2-VASc score is the basis for evaluating the risk of thromboembolic?TE?in patients with non-valvular atrial fibrillation?NVAF?.Anticoagulant therapy is not recommended by current relevant guidelines when the CHA2DS2-VASc score is low?male0,female 1?.However,TE events are not rare in patients with low risk.In addition to the factors included in the score,studies have found that left atrium enlarged,hypertrophic cardiomyopathy?HCM?,proteinuria,chronic kidney disease,hyperuricemia and other factors are also associated with the risk of TE in patients with NVAF.In patients with low-risk NVAF,the analysis of the impact of these factors on TE will help to select patients with relatively high risk of TE among low-risk patients.Research purposesAnalysis of influencing factors of thromboembolic events in patients with CHA2DS2-VASc score low-risk nonvalvular atrial fibrillation.Research methodsThe study included patients with atrial fibrillation hospitalizing in Guangzhou first people's Hospital affiliated to Guangzhou Medical University from January 31,2014 to December 31,2019.The medical records of the patients were reviewed and analyzed.Select the medical records for analysis which meet the following contents at the same time:The inclusion criteria meet the following contents:NVAF,18?age<65 years old,low CHA₂DS₂-VASc score;Exclusion criteria:?1?.Valvular atrial fibrillation after rheumatic heart valve disease,mitral stenosis,and valve replacement;?2?.Previous stroke,non-central TE event,or transient ischemic attack?TIA?Medical history,?3?.Any disease with congestive heart failure?LVEF<50%?,hypertension,diabetes,acute myocardial infarction,complicated aortic atherosclerosis,peripheral arterial disease,?4?.Have a history of malignant tumor,?5?.Severe infection during hospitalization.If there are multiple hospitalizations,only the first hospitalization data will be recorded.Statistical processing method:Patients were divided into control group and embolization group according to whether happened TE events.Data were analyzed by IBM SPSS Statistics 20.0 version computer software.The reasons for hospitalization were confirmed according to the chief medical complaint and the diagnosis of admission,and were divided into two groups according to whether it was the first diagnosis of atrial fibrillation,and the distribution of hospitalization reasons was analyzed.Result1.Baseline characteristicsA total of 5064 patients diagnosed with atrial fibrillation were included in the study.According to the analysis of medical records,178 cases?3.52%?were selected to meet the inclusion and exclusion criteria,including 156 in the control group,22 in the embolization group.TE events accounts for 12.36%of patients with low-risk scores,21 cases of cerebral arterial embolism occurred accounting for 11.80%of patients with low-risk scores,and 3cases of non-central thromboembolism accounting for 1.69%of patients with low-risk scores.In the control group,there were 1 case of HCM,1 case of OSAHS,7 cases of atrial septal defect,2 cases of patent ductus arteriosus,2 cases of CKD,and 2 cases of chronic obstructive pulmonary disease?COPD?,but none were found in the embolization group In the above diagnosed cases,no confirmed cases of left bundle branch block and ventricular septal defect were found in both groups.The distribution of age and asymptomatic atrial fibrillation is significantly different between the two groups?P<0.05?,gender,non-first-diagnosis atrial fibrillation,non-paroxysmal atrial fibrillation,hyperthyroidism?hyperthyroidism?,hyperuricemia,There was no significant difference in blood lipids,urine protein positive,left atrium enlargement,electrocardiogram changes,antiplatelet drugs,anticoagulant drugs?P>0.05?.2.Risk factors affecting TE events in low-risk NVAF patientsLogistic regression analysis showed that age?OR=1.09,95%CI:1.01-1.18,P=0.029?,asymptomatic atrial fibrillation?OR=8.2,95%CI:2.33-28.84,P<0.01?,urine Protein positive?OR=2.93,95%CI:0.84-10.17,P=0.091?and left atrial enlargement?OR=2.38,95%CI:0.92-6.14,P=0.075?are strongly associated with the occurrence of TE events,May be a risk factor for TE.Further logistic multivariate regression analysis showed that age?OR=1.05,95%CI:0.97-1.13,P=0.221?and urine protein positive?OR=3.07,95%CI:0.75-12.54,P=0.118?were not statistically significant Significance,asymptomatic atrial fibrillation?OR=7.42,95%CI:2.01-27.34,P<0.01?and left atrial enlargement?OR=2.86,95%CI:1.02-8.01,P=0.045?are statistically significant,Asymptomatic atrial fibrillation and left atrial enlargement are independent risk factors for TE.3.The reason analysis of hospitalizationAmong the 178 cases of low-risk NVAF,116 cases were the first diagnosis of atrial fibrillation and 62 cases were the non-first diagnosis of atrial fibrillation.There was no significant difference in hospitalization reasons between the first and the first diagnosis of atrial fibrillation?P>0.05?,58 Cases?32.58%?were admitted to hospital for atrial fibrillation arrhythmia,26 cases?14.61%?were admitted to other cardiovascular diseases,and 22 cases?12.36%?were hospitalized due to TE events.Of the 62 non-first-diagnosed atrial fibrillation,9?15%?were hospitalized due to a TE event,and of the 116 first-atrial fibrillation,13?11%?were hospitalized due to a TE event.ConclusionThere are many TE events in NVAF patients with low CHA₂DS₂-VASc score.Age,asymptomatic atrial fibrillation and left atrial enlargement are risk factors for TE in low-risk NVAF,and asymptomatic atrial fibrillation and left atrial enlargement are independent risk factors for TE in low-risk NVAF.