Analysis of risk factors for ischemic stroke in patients with different types of atrial fibrillation

HAN Wen-bing; HU Yuan-hui; JIA Qiu-lei

doi:10.3969/j.issn.1672-5301.2024.08.007

Abstract：Objective To explore the risk factors for ischemic stroke in patients with different types of atrial fibrillation(AF).Methods A total of 751 non-valvular atrial fiibrillation patients who were consecutively admitted to the cardiology department of the Guang'anmen Hospital,China Academy of Chinese Medical Sciences from January 2016 to April 2021 were included.Patients were divided into two groups:the paroxysmal atrial fibrillation(367 cases)and the persistent atrial fibrillation(384 cases).The patients with different types of AF were further divided into the ischemic stroke and non-ischemic stroke groups to analyze the risk factors associated with ischemic stroke.Results Among AF patients with stroke,the proportion of those with persistent AF was higher than those with paroxysmal AF(P＜0.05).In patients with paroxysmal AF,the proportion of those with hypertension,coronary heart disease,heart failure(HF)and diabetes in the stroke group was higher than in the non-stroke group,and the CHA2DS2-VASc score was higher in the stroke group[(5.92±1.41)score vs.(3.97±1.26)score,P＜0.05].Multivariate logistics regression analysis showed that coronary heart disease(OR=3.795,95％CI 1.011-14.241,P＜0.05)and diabetes(OR=2.121,95％CI 1.272-3.536,P＜0.05)were the independent risk factors for ischemic stroke in the patients with paroxysmal AF.In the patients with persistent AF,the proportion of females(P＜0.05)and those with hypertension(P=0.012)in the stroke group was higher than in the non-stroke group;age[(79.34±6.62)years vs.(74.5±9.70)years],left atrial diameter(LAD)[(49.28±4.29)mm vs.(42.13±3.96)mm]and CHA2DS2-VASc score[(3.97±1.38)score vs.(3.61±1.37)score]were all greater in the stroke group compared to the non-stroke group(P＜0.05);the proportion of patients receiving anticoagulation treatment was lower in the stroke group than in the non-stroke group(P＜0.05).Multivariate logistic regression analysis indicated that age(OR=1.062,95％CI 1.025-1.100,P＜0.05),female sex(OR=2.917,95％CI 1.681-5.060,P＜0.05)and LAD(OR=1.165,95％CI 1.105-1.230,P＜0.05)were the independent risk factors for ischemic stroke with persistent AF,while receiving anticoagulation treatment(OR=0.332,95％CI 0.194-0.566,P＜0.05)was the protective factor.Conclusion Coronary heart disease and diabetes are independent risk factors for ischemic stroke in patients with paroxysmal atrial fibrillation.In persistent atrial fibrillation patients,age,female sex,LAD,and anticoagulation status are closely related to ischemic stroke.Therefore,it is crucial to develop appropriate prevention strategies for paroxysmal atrial fibrillation,or actively implement rhythm control and anticoagulation treatment to reduce the risk of ischemic stroke.