Retrospective Analysis of Subtypes and Risk Factors of Ischemic Stroke in Patients with Non-valvular Atrial Fibrillation
|Keywords||ischemic stroke classification non-valvular atrial fibrillation riskfactors|
Objectives:To analysis the ischemic stroke patients with non-valvular atrial fibrillation (NVAF) retrospectively, explore the subtypes of stroke with NVAF, the related risk factors and prognosis.Methods:We screened the in-hospital patients within five years from January1,2006to January1,2011in Department of Neurology of Shandong Provincial Hospital, who were diagnosed with ischemic stroke with atrial fibrillation history, got the detailed clinical data of patients, according to case information, we try to classified ischemic stroke patients with NVAF with different kinds of classification system, record and analysis the relevant factors and prognosis of different subtypes.Results:From2006to2011, a total of2782cases of in-hospital patients with ischemic stroke, within which a total of155(5.6%) cases had atrial fibrillation history,21cases have valvular atrial fibrillation, and the left132cases have non-valvular atrial fibrillation,2cases have dilated cardiomyopathy with atrial fibrillation; In the155cases, only33patients underwent the prevention with drugs (including aspirin, warfarin);32cases of death in these155patients,3in the VAF group, and29cases in the the stroke with NVAF group. The Chief complaints of132cases NVAFIS patients, hemiparesis in98cases (74.2%), aphasia in72cases (54.5%), epilepsia attack in5cases (3.8%), nausea and vomiting in21cases (15.9%), dizziness in24cases (18.1%), headache in7cases (5.3%), incontinence of9cases (6.8%).(1) Compared with the patients NVAF,the patients with VAF are almost female patients (90.5%),and age at onset (59.5±12year),lower than patients with NVAF which have57(43.2%) female patients, and the age of onset (70.9±10year). Patients with NVAF always had a history of hypertension (P=0.009) than patients with VAF. On admission blood lipid check, the cholesterol and low density lipoprotein was significantly higher in patients with NVAF(P=0.03,0.025,respectively). In patients with NVAF, the higher score of the CHADS2, the higher mortality (P=0.007).(2) On the basis of OCSP criteria,of the132patients with NVAF,25(18.9%)had a complete anterior circulation infarct,62(47%) had a partial anterior circulation infarct,31(23.5%) had a posterior circulation infarct, and14(10.6%) had a lacunar infarct; Besides the history of smoking, drinking wine history, mental state on admission, admission blood glucose monitoring and prognosis (mortality) were significantly different (P=0.012,0.017,0.001,0.009,0.0001, respectively), rest of the variables related to stroke were different among the subgroups.(3) On the basis of the TOAST criteria, none of the patients with NVAF could be classified as having had an atherothrombotic stroke. And according to the classification by Hart et al., all of the patients with NVAF,23patients (17.4%) had a definite embolic stroke,40(30.3%) had a probable embolic stroke,28(21.2%) had a possible atherothrombotic stroke,9(6.8%) had a possible lacunar infarction, and32(24.2%) had a stroke of undetermined etiology.On admission, the in-hospital patients’checks of systolic blood pressure, diastolic blood pressure, state of consciousness, admission glucose and outcome (mortality) were significantly different (P=0.025,0.014,0.017,0.047,0.004, respectively), rest of the variables related to stroke were different among the subgroups. Conclusion:(1) The ischemic stroke patients with trial fibrillation who underwent anticoagulant antiplatelet prevention is obviously insufficient, and those patients taking warfarin anticoagulation were in with poor INR control; The poorly control of INR, the higher mortality.(2) Ischemic stroke patients with VAF have earlier age of onset, mostly women; And patients with NVAF have more stroke risk factors for atherosclerosis; CHADS2can be the predictors of stroke prognosis.(3) According to the OCSP classification of ischemic stroke, compared to PACI, POCI and LACI, TACI have a poorer state of consciousness on admission, high mortality and poor prognosis, while TACI group have higher amounts of smoking history, drinking history and higher admission blood glucose.(4) According to the classification of stroke by Hart et al, not all strokes are cardioembolic in origin in these patients. It should also be emphasized that the conventional classification system (TOAST) failed to aid in the correct diagnosis and risk stratification in ischemic stroke patients with atrial fibrillation. Patients with NVAF partly had atherosclerosis stroke. Cardioembolic stroke patients admitted to hospital had higher blood glucose, poorer state of consciousness, and higher mortality; The first symptom of epileptic seizures supports the diagnosis of cardiogenic embolism; The systolic and diastolic blood pressure in admission of lacunar infarction is lower, and the prognosis is good.(5) For NVAF patients, It is important to control the risk factors for atherosclerosis, such as cigrettar,alcohol, blood pressure, blood suger and lipid besides the therapy of anticoagulation or antiplatelet.