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1 Chin J Intern Med, March 2003, Vol 42, No ( ) , 1 086, 3 425, %, ( P < 01001) Logistic :75 ( OR 1176,95 % CI ), ( OR 1152 ; 95 % CI ), ( OR 1139,95 % CI ), ( OR 1171,95 % CI ), ( OR 2177,95 % CI ), ; ; Risk factors for stroke in Chinese with non valvular atrial fibrillation :a case2control study HU Da2yi 3, SUN Yi2hong, ZHOU Zi2qiang, LI Kui2bao, NI Yong2bin, YANG Guang, SUN Shu2hong, LI Lei1 3 Cardiology Department of Renmin Hospital, Peking University, Beijing , China Abstract Objective The aim of this study is to identify the risk factors in Chinese with nonvalvular atrial fibrillation and stroke, using case2control methodology1methods A total of adult patients diagnosed with atrial fibrillation were identified from 18 hospitals over a 22year period1 There were patients with rheumatic valvular atrial fibrillation and patients with nonvalvular atrial fibrillation1 Among the nonvalvular atrial fibrillation patients,827 had ischemic stroke1 The data of the patients having nonvalvular atrial fibrillation with stroke was compared with those having nonvalvular atrial fibrillation without stroke ( n = 2 598) 1 The effect of each variable on stroke was assessed with a logistic regression analysis1 Results The studied cases with stroke and controls without stroke were similar in terms of percentage with sex, a past history of congestive heart failure, myocardial infarction, and mean left atrial size1 Cases were significantly older than controls ( vs , P < 01001) and more likely to have a history of hypertension(7110 % versus 5116 %, P < 01001) and diabetes(1719 % vs %, P = 01001) 1 There is strong evidence that left atrial (LA) thrombi make AF patients highly risky for stroke1 In multivariate analysis, age 75 ( OR 1176 ; 95 % CI ), history of hypertension( OR 1152 ;95 % CI ), diabetes ( OR 1139 ;95 % CI ), high systolic blood pressure ( OR 1171 ;95 % CI ), LA thrombi ( OR 2177 ;95 % CI ) were independently associated with stroke1 The lack of the association between left ventricular dysfunction and stroke is due to the relatively incorrect diagnosis of heart failure in the context of atrial fibrillation1 Conclusions Our analysis suggests that old age, hypertension, diabetes, high systolic blood pressure and LA thrombi detected with echocardiography are independent risk factors, which should be considered when decision of long2term anticoagulation therapy to prevent stroke with nonvalvular atrial fibrillation is to be made1 Key words Atrial fibrillation ; Cerebrovascular accident ; Risk factors ( ) [1 5 %, 015 %12 % ], 15 %20 %, : (WKZ ) : ( ) ; ( ), : ( > 75 )

2 Chin J Intern Med, March 2003, Vol 42, No. 3 [2 ] 2 visual foxpro610, ), OR 95 % CI, 18 : : Logistic , 18, 1. : 30 s P 1. : 18, F 5 074, 563, ( / min) 4 511, : (AMI), % ;,,4318 % :, %, 2. : : 273 (26188 %),, 827 (24115 %) : < 60, (13118 %) (1) : < 7d, 1, : 7d 1 1. : : (1) ( 12 ), : ; (2) 2. :,,, (MI),,,,, 3. :,,, (), CT MRI 4. :, 2. :, (5319 %4611 %),, ( P = 01135), 2 Framingham : (75 ) [3 ], : (TIA),,, ( P = 01299) ( P = 01686) (CT MRI) SPSS1010, t, ( MI TIA (95 % CI ) (2) ( P < 01001),

3 Chin J Intern Med, March 2003, Vol 42, No ( )2 () OR P < < < ( P = 01009), (3, P = 0121) ( ) ( P = 01031), ( EF < 50 %),,, ( P > 0105,4), 25 % 31 :,: Logistic,, :,75,, ( ), (5) %, %, ( )2 ( gx s) (mm Hg) (mm Hg) OR P < < < (mm) > 50 mm EF < 50 % OR P :1 mm Hg = kpa 3 ( ) OR : 3, P < ; 3 3, P = ;, P = OR 95 % CI P ( 75 ) , , , , , Frammingham % [3 ]

4 Chin J Intern Med, March 2003, Vol 42, No. 3 : ( > 75 ), : AFI SPAF, [4,5 ], 73, 1/ 3 ( 68 ), (LA), (LAA), [6 ], [7 LA/ LAA ],,, SPAF,, (, ), > 75,,, AFI SPAF AFFIRM,85 %, 90 % , 1171, :, LA, [10 LAA, SPAF, ], :,, [8 ],,, > 50 mm,, INR EF (210310),, ( ), : ( TEE) : LAA,, TEE,, AFI,, [9 ], EF 1 Arboix A, GE Lluis, Massons JB, et al. Atrial fibrillation and stroke : clinical presentation of cardioembolic versus atherothrombotic infarction. Int J of Cardiol,2000,73 : Hart RG, Benavente O, McBride R, et al. Antithrombotic therapy to prevent stroke in patients with atrial fibrillation : a meta2analysis. Ann Intern Med,1999,131 : Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke : the Framingham Study. Stroke, 1991, 22 : 9832

5 Chin J Intern Med, March 2003, Vol 42, No Atrial fibrillation investigators : echocardiographic predictors of stroke in patients with atrial fibrillation : a prospective study of 1,066 patients from three clinical trials. Arch Intern Med,1998,158 : Transesophageal echocardiographic correlates of thromboembolism in high2risk patients with nonvalvular atrial fibrillation. The Stroke Prevention in Atrial Fibrillation Investigators Committee on Echocardiography. Ann Intern Med,1998,128 : Asinger RW, Koehler J, Pearce LA, et al. Pathophysiologic correlates of thromboembolism in nonvalvular atrial fibrillation :. Dense spontaneous echocardiographic contrast ( The Stroke Prevention in Atrial Fibrillation [ SPAF2III] study). J Am Soc Echocardiogr,1999,12 : Cushman M, Pasty BM, Macy E,et al. Correlates of thrombin markers in an elderly cohort free of clinical cardiovascular disease. Arterioscler Thromb Vasc Biol,1996,16 : Schmieder RE, Martus P, Klingbeil A. Reversal of left ventricular hypertrophy in essential hypertension. A meta2analysis of randomized double2blind studies.jama,1996,275 : Atrial fibrillation Investigators. Risk factors for stroke and efficacy of anti2thrombotic therapy in atrial fibrillation : analysis of pooled data from five randomized controlled trials. Arch Intern Med, 1994, 154 : Williams ES, Miller JM. Results from late2breaking clinical trial sessions at the American College of Cardiology 51st Annual Scientific Session. J Am Coll Cardiol,2002,40 :1218 ( : ) ( : ),,30 d,,, Xa,,,, a [1 ] [3 60 a, a ],, a 11 :60,34,26, (64 [2 12), ] :, 7, 36, 4, 7, 6 12,,, 50, : 12, 23, 15, : a a, 1989 Braunwald UA,,, 22, 26, 12 APTT,,, :, : : < 50 kg 014 mg, > 50 kg 016 mg, 7d 1 Warkentin TE, Levine MN, Hirsh J, et al. Heparin2induced thrombocytopenia in patients treated with low molecular2weight heparin or : 2 000U, U/ h 7d ACT APTT APTT ,2000,28 : / d, 3d, d 3 Toschi V, Ggallo R, Lettino M, et al. Tissuefacctor modulates the 30 d thrombogenility of human atherosclerotic pluqques, Circulation, 1997, 95 : Aaantman EM, Handin R. Low2molecular2weight heparins : an : t intrigucing new twist with profound implication. Circulation, 1998,98 : 21 :,, ( : ) :100007, [4 ], unfractionated heparin. N Engl J Med, 1995,332 : ( : )