University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham B18 7QH, UK.
Int J Cardiol. 2013 Sep 10;167(6):2682-7. doi: 10.1016/j.ijcard.2012.06.118. Epub 2012 Jul 15.
Risk of stroke and thromboembolism (TE) in patients with non-valvular atrial fibrillation (NVAF) is categorised in stroke risk stratification scores. The role of pattern of NVAF in risk prediction is unclear in contemporary 'real world' cohorts.
Patients with NVAF in a four-hospital-institution between 2000 and 2010 were included. Stroke/TE event rates were calculated according to pattern of AF, i.e. paroxysmal, persistent and permanent. Risk factors were investigated by Cox regression. Among 7156 NVAF patients, 4176 (58.4%) patients with paroxysmal, 376 (5.3%) with persistent and 2604 (36.3%) with permanent patterns of NVAF were included. In non-anticoagulated patients, overall stroke/TE event rate per 100 person-years was 1.29 (95% CI 1.13-1.47). Compared with paroxysmal NVAF, rates of stroke/TE, bleeding and all-cause mortality (p<0.001) were significantly higher in permanent NVAF patients but not in persistent NVAF patients. In multivariate analyses, previous stroke (hazard ratio, HR 2.58, 95% CI 2.08-3.21), vascular disease (HR 1.34, 1.12-1.61), heart failure (HR 1.20, 1.00-1.44), age ≥ 75 years (HR 2.75, 2.16-3.50) and age 65-74 years (HR 1.60, 1.22-2.09) independently increased stroke/TE risk, but not persistent (HR 1.13, 0.76-1.70) and permanent (HR 1.44, 0.96-2.16) NVAF patterns.
In this large 'real world' NVAF cohort, rates of stroke, TE, death and bleeding differed significantly by patterns of NVAF. However, only previous stroke, age, heart failure and vascular disease (not pattern of NVAF) independently increased risk of adverse outcomes in multivariate analyses. Thus, stroke risk is similar across all patterns of NVAF and antithrombotic therapy should be based on clinical risk factors, not on arrhythmia pattern.
非瓣膜性心房颤动（NVAF）患者的中风和血栓栓塞（TE）风险在中风风险分层评分中进行分类。在当代“真实世界”队列中，NVAF 模式在风险预测中的作用尚不清楚。
本研究纳入了 2000 年至 2010 年期间在四家医院机构的 NVAF 患者。根据 AF 模式（即阵发性、持续性和永久性）计算中风/TE 事件发生率。通过 Cox 回归研究危险因素。在 7156 例 NVAF 患者中，4176 例（58.4%）为阵发性、376 例（5.3%）为持续性和 2604 例（36.3%）为永久性 NVAF 患者。在未抗凝的患者中，每 100 人年中风/TE 事件发生率为 1.29（95%CI 1.13-1.47）。与阵发性 NVAF 相比，永久性 NVAF 患者的中风/TE、出血和全因死亡率（p<0.001）显著更高，但持续性 NVAF 患者则不然。多变量分析显示，既往中风（风险比，HR 2.58，95%CI 2.08-3.21）、血管疾病（HR 1.34，1.12-1.61）、心力衰竭（HR 1.20，1.00-1.44）、年龄≥75 岁（HR 2.75，2.16-3.50）和年龄 65-74 岁（HR 1.60，1.22-2.09）均独立增加中风/TE 风险，但持续性（HR 1.13，0.76-1.70）和永久性（HR 1.44，0.96-2.16）NVAF 模式则不然。
在这项大型“真实世界”NVAF 队列研究中，NVAF 模式的中风、TE、死亡和出血率差异显著。然而，多变量分析仅显示既往中风、年龄、心力衰竭和血管疾病（而非 NVAF 模式）独立增加不良结局风险。因此，中风风险在所有 NVAF 模式中相似，抗血栓治疗应基于临床危险因素，而不是心律失常模式。
