Von Willebrand factor in evaluating stroke risk of patients with new-onset atrial fibrillation after elective percutaneous coronary intervention / 临床检验杂志

ABSTRACT

Objective To assess stroke risk in the patients with new-onset atrial fibrillation (AF) after elective percutaneous coronary intervention (PCI) by von Willebrand factor antigen (vWF∶Ag).Methods A total of 127 patients with new-onset atrial fibrillation after PCI (new-onset AF after PCI group),50 new inpatients with acute coronary syndrome without undergoing PCI (ACS control),50 patients without AF after PCI (PCI control) and 50 healthy individuals (healthy control) were selected in Tianjin Medical University General Hospital from 2016 February to 2017 February for retrospective cohort study.To assay the plasma vWF∶Ag for all objects,receiver operating characteristic curve (ROC) was used to analyze the predicting performance of vWF∶Ag with stroke risk in the patients with new-onset AF.x2 test was used to analyze the relevance between vWF∶Ag and clinical pathological factors in the patients with new-onset AF.Kaplan-Meier curve was used to implement survival analysis.Results The results of plasma vWF∶Ag were as follows:104.5％ (88.0％,133.7％) for the control group,161.7％ (120.7％,270.5％) for ACS control group,208％ (125.2％,360.7％) for PCI control group and 284.9％ (172.4％,494.2％) for new-onset AF after PCI group,respectively.The level of plasma vWF∶Ag of PCI control was higher than that of ACS control (U =526.0,P ＜0.01) and the level in new-onset AF after PCI group was higher than that of PCI control (U =824.0,P ＜ 0.01).The area under the curve was 0.882 (95％ CI:0.811-0.854) for plasma vWF∶Ag level predicting stroke risk with new-onset AF.When the cut-off value of vWF∶Ag was defined as 312.0％,the sensitivity was 94.4％ and specificity was 60.6％.Compared with the patients whose vWF∶Ag was less than 312.0％,the cumulative probability increased significantly (Log-rankx2 =44.308,P ＜ 0.01) during 90 days of follow-up period in the patients with new-onset AF after PCI whose vWF∶Ag was over 312.0％.There were relevances between the vWF∶Ag level and chronic heart failure/left ventricular dysfunction,hypertension,age,stroke/transient ischemic attack (TIA)/history of thromboembolism and vascular disease (P ＜ 0.01).The level of plasma vWF∶Ag and risk of stroke event in the patients with dual antithrombotic therapy were higher than those of the patients with triple antithrombotic therapy (U =1 075.5,P ＜ 0.01;x2 =10.45,P ＜ 0.01).Conclusion The level of plasma vWF ∶ Ag could reflect the damage condition of vascular endothelial cells,stroke risk and the efficacy of anticoagulant therapy in the patients with new-onset atrial fibrillation after PCI.