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根据房颤模式评估缺血性卒中风险:ACTIVE-A 和 AVERROES 中 6563 例阿司匹林治疗患者的分析。

Risk of ischaemic stroke according to pattern of atrial fibrillation: analysis of 6563 aspirin-treated patients in ACTIVE-A and AVERROES.

机构信息

Population Health Research Institute, McMaster University and Hamilton Health Sciences, 237 Barton St. E., Hamilton, ON, Canada L8L 2X2

Population Health Research Institute, McMaster University and Hamilton Health Sciences, 237 Barton St. E., Hamilton, ON, Canada L8L 2X2.

出版信息

Eur Heart J. 2015 Feb 1;36(5):281-7a. doi: 10.1093/eurheartj/ehu307. Epub 2014 Sep 3.

Abstract

AIMS

The pattern of atrial fibrillation (AF) occurrence-paroxysmal, persistent, or permanent-is associated with progressive stages of atrial dysfunction and structural changes and may therefore be associated with progressively higher stroke risk. However, previous studies have not consistently shown AF pattern to predict stroke but have been hampered by methodological shortcomings of low power, variable event ascertainment, and variable anticoagulant use.

METHODS AND RESULTS

We analysed the rates of stroke and systemic embolism in 6563 aspirin-treated patients with AF from the ACTIVE-A/AVERROES databases. There was thorough searching for events and adjudication. Multivariable analyses were performed with the adjustment for known risk factors for stroke. Mean age of patients with paroxysmal, persistent, and permanent AF was 69.0 ± 9.9, 68.6 ± 10.2, and 71.9 ± 9.8 years (P < 0.001). The CHA2DS2-VASc score was similar in patients with paroxysmal and persistent AF (3.1 ± 1.4), but was higher in patients with permanent AF (3.6 ± 1.5, P < 0.001). Yearly ischaemic stroke rates were 2.1, 3.0, and 4.2% for paroxysmal, persistent, and permanent AF, respectively, with adjusted hazard ratio of 1.83 (P < 0.001) for permanent vs. paroxysmal and 1.44 (P = 0.02) for persistent vs. paroxysmal. Multivariable analysis identified age ≥ 75 year, sex, history of stroke or TIA, and AF pattern as independent predictors of stroke, with AF pattern being the second strongest predictor after prior stroke or TIA.

CONCLUSION

In a large population of non-anticoagulated AF patients, pattern of AF was a strong independent predictor of stroke risk and may be helpful to assess the risk/benefit for anticoagulant therapy, especially in lower risk patients.

摘要

目的

心房颤动(AF)的发作模式-阵发性、持续性或永久性-与心房功能障碍和结构变化的进展阶段相关,因此可能与逐渐升高的中风风险相关。然而,先前的研究并未一致表明 AF 模式可预测中风,但由于功率低、事件确定的可变性和抗凝剂使用的可变性等方法学上的缺陷而受到阻碍。

方法和结果

我们分析了来自 ACTIVE-A/AVERROES 数据库的 6563 例接受阿司匹林治疗的 AF 患者的中风和全身性栓塞的发生率。对事件进行了彻底的搜索和裁决。进行了多变量分析,并调整了中风的已知危险因素。阵发性、持续性和永久性 AF 患者的平均年龄分别为 69.0±9.9 岁、68.6±10.2 岁和 71.9±9.8 岁(P<0.001)。阵发性和持续性 AF 患者的 CHA2DS2-VASc 评分相似(3.1±1.4),但永久性 AF 患者的评分更高(3.6±1.5,P<0.001)。阵发性、持续性和永久性 AF 的年缺血性中风发生率分别为 2.1%、3.0%和 4.2%,永久性 AF 与阵发性 AF 的调整后的危险比为 1.83(P<0.001),持续性 AF 与阵发性 AF 的调整后的危险比为 1.44(P=0.02)。多变量分析确定年龄≥75 岁、性别、中风或 TIA 病史以及 AF 模式是中风的独立预测因素,AF 模式是中风或 TIA 病史后的第二大预测因素。

结论

在非抗凝 AF 患者的大人群中,AF 模式是中风风险的强有力独立预测因素,可能有助于评估抗凝治疗的风险/获益,尤其是在低风险患者中。

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