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Additional criteria for stratifying the ischemic stroke risk in patients with atrial fibrillation and one non‑sex‑related point on the CHA2DS2‑VASc scale

Nicolin D. Y.1, Grachev V. G.2, Lipchenko A. A.2, Fokina E. G.1, Arkhipov M. V.2
1 – Limited Liability Company Medical Foundation “Novaya Bolnitsa”, Zavodskaya str. 29, Ekaterinburg 620109
2 – Federal State Budgetary Educational Institution of Higher Professional Education “Ural State Medical University” of the Ministry of Health of the Russian Federation, Repina str. 3, Ekaterinburg 620028

Keywords: atrial fibrillation, stroke, risk stratification

DOI: 10.18087/rhj.2017.3.2353

Background. The oral anticoagulant treatment is recommended for prevention of stroke and other thromboembolic complications related with atrial fibrillation (AF). Is was suggested to use formal scales, specifically the CHA2DS2‑VASc scale, to determine indications for this treatment. Aim. To identify characteristics not included into the CHA2DS2‑VASc scale, which influence the risk of ischemic stroke in patients with AF and one non‑sex‑related risk factor (RF) for thromboembolic complications on this scale. Materials and methods. A “case‑control” study was performed using data of a retrospective analysis of case reports of patients with AF. The main group consisted of patients with non‑valvular AF and one additional to sex CHA2DS2‑VASc RF who were admitted during the period preceding the development of stroke. The reference group included matched by demographic characteristics patients with non‑valvular AF and one additional to sex CHA2DS2‑VASc RF who had no stroke or systemic embolism. Medical history data, results of ECG, EchoCG and ultrasound duplex scanning of brachiocephalic arteries (USDS BCA) were analyzed. Results. The main group included 50 patients aged 62.5 (58.75; 69.25), of which women were 32%; the reference group included 68 patients aged 62 (57.0; 64.0), of which 38.2% were women. The main group compared to the reference group had significantly higher incidences of permanent AF (48% vs 23.9%; р=0.01), EchoCG signs of LV hypertrophy (LVH) (68% vs 44.1%; р=0.015), and thickened intima‑media complex (IMC) >0.9 mm as shown by USDS BCA (68% vs 22.1%; р<0.0001). The monofactorial analysis demonstrated a significant increase in risk for ischemic stroke in the presence of permanent AF (HR , 2.552; 95% CI from 1.233 to 5.281), EchoCG evidence of LVH (HR , 2.673; 95% CI from 1.252 to 5.709), and thickened IMC (HR , 5.536; 95% CI from 2.643 to 11.594). Conclusion. Data of EchoCG and USDS BCA and the AF type should be taken into account in evaluating the risk for ischemic stroke and considering administration of oral anticoagulants for patients with AF and one additional to sex CHA2DS2‑VASc RF who have non‑absolute indications for anticoagulant therapy.
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Nicolin D. Y., Grachev V. G., Lipchenko A. A., Fokina E. G., Arkhipov M. V. Additional criteria for stratifying the ischemic stroke risk in patients with atrial fibrillation and one non‑sex‑related point on the CHA2DS2‑VASc scale. Russian Heart Journal. 2017;16 (3):197–203

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