First Division, Department of Cardiology, The Second Hospital of Hebei Medical University and Institute of Cardiocerebrovascular Disease of Hebei Province, No. 215, Heping West Road, Shijiazhuang, 050000, Hebei, China.
Department of Cardiology, Coronary Heart Disease Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.
BMC Cardiovasc Disord. 2021 Oct 2;21(1):474. doi: 10.1186/s12872-021-02276-z.
Recent evidence has shown that the pathogenesis of ischaemic stroke associated with atrial fibrillation (AF) is complex and involves other factors in addition to arrhythmias. The purpose of this study was to investigate the relationship among AF, CHADS-VASc score and ischaemic stroke in patients with coronary artery disease (CAD) in Hebei, China.
A total of 2,335 patients with CAD from September 2016 to May 2019 at the Second Hospital of Hebei Medical University were included (mean age 62.73 ± 10.35 years, range 26-92 years; 41.58% female). This was a cross-sectional study, and participants were divided into non-stroke (n = 1997) and ischaemic stroke groups (n = 338). Propensity score matching (PSM) was performed to match ischaemic stroke patients with non-stroke patients in a 1:4 ratio. The relationship among AF, the CHADS-VASc score and ischaemic stroke was evaluated using univariable generalized linear models for different sex, age, body mass index (BMI), CAD and CHADS-VASc score subgroups. Univariable and multivariable generalized linear models were used to evaluate the relationship between AF and ischaemic stroke in the different models.
Compared with that in the non-stroke group, the prevalence of AF (8.81% vs. 14.20%, P = 0.002) in the ischaemic stroke group was higher. The proportion of patients with ischaemic stroke was significantly different between the AF group and the non-AF group (28.74% vs. 19.04%, P = 0.003). An increasing CHADS-VASc score was associated with a gradual increase in the prevalence of AF (P for trend < 0.001). Subgroup analysis showed that the trend towards increased stroke risk in the AF group was consistent across the various subgroups. The multivariable analysis demonstrated that AF was not associated with ischaemic stroke compared with the absence of AF (OR = 1.55, 95% CI 0.94-2.56, P = 0.087).
In our cross-sectional study, after adjustment for confounding factors, there was no association between AF and ischaemic stroke. The increased risk of ischaemic stroke associated with AF was attenuated by atherosclerotic factors. Our study supports the current view that enhanced control of modifiable cardiovascular risk factors in patients with AF is essential.
最近的证据表明，与心房颤动（AF）相关的缺血性中风的发病机制很复杂，除了心律失常外，还涉及其他因素。本研究的目的是探讨在中国河北的冠心病（CAD）患者中，AF、CHADS-VASc 评分与缺血性中风之间的关系。
本研究共纳入了 2016 年 9 月至 2019 年 5 月在河北医科大学第二医院就诊的 2335 例 CAD 患者（平均年龄 62.73±10.35 岁，范围 26-92 岁；41.58%为女性）。这是一项横断面研究，参与者被分为非中风组（n=1997）和缺血性中风组（n=338）。采用倾向评分匹配（PSM）以 1:4 的比例将缺血性中风患者与非中风患者相匹配。采用单变量广义线性模型评估不同性别、年龄、体重指数（BMI）、CAD 和 CHADS-VASc 评分亚组中 AF、CHADS-VASc 评分与缺血性中风之间的关系。采用单变量和多变量广义线性模型评估不同模型中 AF 与缺血性中风之间的关系。
与非中风组相比，缺血性中风组 AF 的患病率（8.81%比 14.20%，P=0.002）更高。AF 组和非 AF 组之间的缺血性中风患者比例差异有统计学意义（28.74%比 19.04%，P=0.003）。CHADS-VASc 评分的增加与 AF 患病率的逐渐增加呈正相关（趋势 P<0.001）。亚组分析表明，AF 组的中风风险呈逐渐增加的趋势，且在各亚组中一致。多变量分析表明，与不存在 AF 相比，AF 与缺血性中风无相关性（OR=1.55，95%CI 0.94-2.56，P=0.087）。
在本横断面研究中，调整混杂因素后，AF 与缺血性中风之间无关联。与 AF 相关的缺血性中风风险增加被动脉粥样硬化因素所减弱。我们的研究支持目前的观点，即强化控制 AF 患者的可改变心血管危险因素至关重要。
