title: Risk factors and incidence of stroke and MACE in Chinese atrial fibrillation patients presenting to emergency departments: a national wide database analysis.
abstract: BACKGROUND
  Contemporary clinical risk stratification schemata for predicting stroke and thromboembolism in patients with atrial fibrillation (AF) are largely derived from western cohorts. The purpose of the present study is to assess the potential risk factors for stroke and major adverse cardiac events (MACE) in a large population of Chinese AF patients presenting to emergency department.
  
  
  METHODS
  The Chinese AF registry is a multicenter, prospective, observational study with 1 year follow up. Patients who presented to an emergency department with atrial fibrillation or atrial flutter were recruited from November 2008 to October 2011. The MACE included all cause mortality, stroke, non-central nervous system systemic embolism and major bleed.
  
  
  RESULTS
  A total of 2016 AF patients (1104 women) were included in the final analysis. Multivariate Cox regression analysis showed that the risk factors for stroke were female gender (1.419 (1.003-2.008), p=0.048), age ≥ 75 (2.576 (1.111-4.268), p<0.001), previous stroke/TIA (2.039 (1.415-2.939), p<0.001), LVSD (1.700 (1.015-2.848), p=0.044) and previous major bleeding (2.481 (1.141-5.397), p=0.022). For MACE, age ≥ 75 (3.042 (2.274-4.071), p<0.001), heart failure (1.371 (1.088-1.728), p=0.008), previous stroke/TIA (1.560 (1.244-1.957), p<0.001), LVSD (1.424 (1.089-1.862), p=0.010) and COPD (1.393 (1.080-1.798), p=0.011) were independent risk factors. History of hypertension and diabetes was not associated with the events, neither stroke nor MACE. For non-anticoagulation patients, the c-statistic for predicting stroke was 0.685 (0.637-0.732) and for MACE was 0.717 (0.687-0.746), respectively.
  
  
  CONCLUSIONS
  We demonstrated that, except for the traditional risk factors, clinicians should pay more attention to patients with prior major bleeding or COPD in Chinese AF patients presenting to emergency department.
authors.affiliation: Emergency and Intensive Care Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Yan-Min
authors.initials: YM
authors.lastname: Yang
authors.affiliation: Emergency and Intensive Care Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Xing-Hui
authors.initials: XH
authors.lastname: Shao
authors.affiliation: Emergency and Intensive Care Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Electronic address: junzhuld@hotmail.com.
authors.forename: Jun
authors.initials: J
authors.lastname: Zhu
authors.affiliation: Emergency and Intensive Care Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Han
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Emergency and Intensive Care Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Yao
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Emergency and Intensive Care Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Gao
authors.affiliation: Emergency and Intensive Care Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Li-Sheng
authors.initials: LS
authors.lastname: Liu
authors.affiliation: Emergency and Intensive Care Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Li-Tian
authors.initials: LT
authors.lastname: Yu
authors.affiliation: Department of Emergency, Fu Xing Hospital, Capital Medical University, Beijing, China.
authors.forename: Li
authors.initials: L
authors.lastname: Zhao
authors.affiliation: Department of Cardiology, Pingdu People's Hospital, Pingdu, Shandong, China.
authors.forename: Peng-Fei
authors.initials: PF
authors.lastname: Yu
authors.affiliation: Department of Emergency, Qingdao Municipal Hospital, Qingdao, Shandong, China.
authors.forename: Hua
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Emergency, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: He
authors.affiliation: Department of Emergency, Sixth People's Hospital of Chengdu, Chengdu, Sichuan, China.
authors.forename: Xiao-Dan
authors.initials: XD
authors.lastname: Gu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D044466:Asian People / Q000706:statistics & numerical data*; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000208:ethnology / Q000401:mortality*; D001282:Atrial Flutter / Q000188:drug therapy / Q000208:ethnology / Q000401:mortality*; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy / Q000208:ethnology / Q000401:mortality*; D006470:Hemorrhage / Q000208:ethnology; D006801:Humans; D015994:Incidence; D008297:Male; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000208:ethnology; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy / Q000208:ethnology / Q000401:mortality*
chemical_list: D000925:Anticoagulants
keywords: Atrial fibrillation; MACE (major adverse cardiac events); Risk factors; Stroke