Comparison Of CHA₂DS₂-VASc Score And ATRIA Score In Predicting Risk Factors And Risk Factors In Patients

Background and Objective:Atrial fibrillation（atrialfibrillation,AF）,referred to as atrial fibrillation,is one of the most common arrhythmias and an important cause of ischemic stroke（ischemicstroke,IS）.There are about 15-2 million ischemic stroke in China every year,among which the stroke mainly caused by atrial fibrillation is the most common,with high mortality and disability rate.If we can accurately predict the patients with atrial fibrillation before the onset of the disease,it can provide a more scientific treatment plan for the clinic.CHA₂DS₂-VASc score is a risk assessment scale for stroke in patients with atrial fibrillation recommended by the guidelines.However,the CHA₂DS₂-VASc score classifies most people into high-risk categories,and failure to better identify patients with a really low risk of thromboembolic events may lead to unnecessary use of anticoagulants in these low-risk patients and unnecessary risk of bleeding.In recent years,many studies have tried to improve the CHA₂DS₂-VASc score,and found that adding risk factors such as renal insufficiency and type of atrial fibrillation to the score can increase the sensitivity of predictive score.In order to make up for these deficiencies,constantly updated stroke risk scores,such as ATRIA score（Anticogulation and Risk Factorsin Atrial Fibrillation）,include renal insufficiency into the criteria,while taking different scores according to whether or not previous stroke history is combined.However,some studies have found that the stroke risk of patients whose ATRIA score is"low risk"is significantly higher than that of patients whose CHA₂DS₂-VASc score is"low risk".The incidence of middle-aged stroke in patients with low risk ATRIA score is as high as 2.75%,and there are few studies on ATRIA score in our country.Whether it is applicable to the situation of our country remains to be further explored.The purpose of this study was to compare the differences of risk factors in CHA₂DS₂-VASc score and ATRIA score in patients with atrial fibrillation with ischemic stroke,as well as the use of anticoagulants in each risk stratification.Methods:1.Patients with ischemic stroke with atrial fibrillation in the Stroke Center of the first affiliated Hospital of Dali University from January 2019 to December 2022were collected.The patients were divided into two groups according to ATRIA score and CHA₂DS₂-VASc score respectively,and the clinical data were collected.2.The patients were divided into low risk group,medium risk group and high risk group according to ATRIA score and CHA₂DS₂-VASc score.The risk factors of each group were collected,including hypertension,diabetes,hyperlipidemia,coronary heart disease,paroxysmal atrial fibrillation,hyperuricemia,smoking history and so on.3.The risk factors of ischemic stroke in patients without anticoagulation were compared and analyzed with ATRIA score and CHA₂DS₂-VASc score scale.4.The use of anticoagulants in each risk stratification of ATRIA score and CHA₂DS₂-VASc score scale were statistically analyzed.5.The risk factors of ischemic stroke in patients with atrial fibrillation who received actual anticoagulation therapy were analyzed in patients with ATRIA score and CHA₂DS₂-VASc score who needed anticoagulation therapyResults:Among the 262 hospitalized patients with atrial fibrillation and ischemic stroke,the CHA₂DS₂-VASc score was divided into low risk group（6 cases,2.29%）,medium risk group（15 cases,5.73%）,high risk group（91.98%）,low risk group（46.18%）,medium risk group（34 cases,12.98%）and high risk group（40.84%）.In the CHA₂DS₂-VASc score,ischemic stroke occurred in 21 patients without anticoagulation,accounting for 8%.The risk factors outside the score items were analyzed,and it was found that the left atrial diameter was increased in patients without anticoagulation,indicating that the risk factor for ischemic stroke in patients without anticoagulation was the increase in left atrial diameter.In ATRIA score,ischemic stroke occurred in 121patients without anticoagulation,accounting for 46.2%.The risk factors outside the score items were analyzed,and it was found that the left atrial diameter was enlarged,and the number of hyperlipidemia,hyperuricemia and smoking in the group without anticoagulation were more than those in the group without anticoagulant.The results showed that the risk factors of ischemic stroke in patients without anticoagulation were enlargement of left atrial diameter,hyperlipidemia,hyperuricemia and smoking.In the CHA₂DS₂-VASc evaluation scale,there were 241patients（≥2 points）,135 patients（56%）were treated with anticoagulants,90 cases（66.7%）were complicated with atherosclerotic plaque,141cases（52.5%）were treated with anticoagulants in ATRIA scale（≥6 points）,and 54 cases（73%）were complicated with atherosclerotic plaques.These patients who need anticoagulants have been treated with anticoagulants,but have ischemic stroke,indicating that the risk factor for ischemic stroke in patients with atrial fibrillation treated with anticoagulant therapy is atherosclerotic plaque.According to the CHA₂DS₂-VASc score,there were 241 patients who needed anticoagulant therapy,and56%of the patients who actually used anticoagulants needed anticoagulant therapy.The proportion of patients who actually used anticoagulants was 52.5%.Compared with the criteria recommended in the guidelines,the patients we studied were inadequate and unreasonable,and there was a large gap between the patients we studied and the recommendations of the guidelines.In the ATRIA assessment scale,there were121patients in the low-risk stratification group,of which 46 patients were not treated with anticoagulants,accounting for 38%.If the risk stratification was redone with CHA₂DS₂-VASc score,it would be divided into low-risk group（n=3）,medium-risk group（n=4）and high-risk group（n=39）.Among the 39 cases in the high-risk group,these patients needed anticoagulant therapy if they were scored according to the CHA₂DS₂-VASc assessment scale,indicating that there was insufficient anticoagulation in the ATRIA score.Conclusion:1.Among the risk factors other than the CHA₂DS₂-VASc score,the risk factor for ischemic stroke in patients with atrial fibrillation without anticoagulation was increased left atrial diameter.2.Among the risk factors other than ATRIA score,the risk factors for ischemic stroke in patients with atrial fibrillation without anticoagulation were enlarged left atrial diameter,hyperlipidemia,hyperuricemia and smoking.3.In patients with atrial fibrillation who need anticoagulation therapy,the risk factor for ischemic stroke in patients with atrial fibrillation treated with anticoagulant therapy is atherosclerotic plaque.4.ATRIA score showed insufficient anticoagulation in the low risk stratified group.