Division of Cardiology, Department of Medicine, China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.
Division of Cardiology, Department of Medicine, China Medical University Hospital, Taichung, Taiwan.
Mayo Clin Proc. 2014 Nov;89(11):1487-97. doi: 10.1016/j.mayocp.2014.08.015. Epub 2014 Nov 3.
To assess the risk of first-ever ischemic stroke in younger patients with atrial fibrillation (AF) who have none of the CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, previous stroke/transient ischemic attack, vascular disease, age 65-74 years, sex category [female sex]) risk factors (excluding female sex) by using the National Health Insurance research database in Taiwan.
From 22,842,778 insured people, we identified 24,612 hospitalized patients with newly diagnosed AF between January 1, 2002, and December 31, 2004, as the AF group and randomly selected 98,448 age- and sex-matched persons without AF as the non-AF group. Both groups were followed up until December 31, 2010, to estimate ischemic stroke incidences in relation to other stroke risk factors.
During a follow-up period of 89,468 person-years, the stroke rate was higher in patients with AF than in those without AF (5.79 per 100 person-years vs 2.25 per 100 person-years). The higher prevalence of CHA2DS2-VASc comorbidities (heart failure, hypertension, diabetes, coronary artery disease, and peripheral artery disease) in patients with AF further increased the stroke risk. In 790 patients with AF aged 30 to 55 years who had none of the CHA2DS2-VASc comorbidities at baseline and retained a "low risk," that is, those with a CHA2DS2-VASc score of 0 in men and 1 in women during follow-up, the stroke rate remained considerably higher than that in their non-AF counterparts (1.00 per 100 person-years vs 0.25 per 100 person-years), with a sex-adjusted hazard ratio of 4.09 (95% CI, 2.97-5.62).
This study finds an increased risk of stroke in younger patients with AF who are not recommended for prevention of thromboembolism by current guidelines. Better stroke risk stratification tools are needed to prioritize younger patients with AF for thromboprophylactic therapy in this population.
利用台湾全民健康保险研究数据库，评估无 CHA2DS2-VASc（充血性心力衰竭、高血压、年龄≥75 岁、糖尿病、既往卒中/短暂性脑缺血发作、血管疾病、年龄 65-74 岁、性别[女性]）危险因素（不包括女性）的年轻心房颤动（AF）患者首次发生缺血性卒中的风险。
从 22842778 名被保险人中，我们确定了 2002 年 1 月 1 日至 2004 年 12 月 31 日期间新诊断为 AF 的 24612 例住院患者作为 AF 组，并随机选择了 98448 名年龄和性别匹配的无 AF 患者作为非 AF 组。两组均随访至 2010 年 12 月 31 日，以评估与其他卒中危险因素相关的缺血性卒中发生率。
在 89468 人年的随访期间，AF 患者的卒中发生率高于无 AF 患者（5.79/100 人年 vs 2.25/100 人年）。AF 患者中 CHA2DS2-VASc 合并症（心力衰竭、高血压、糖尿病、冠状动脉疾病和外周动脉疾病）的患病率较高，进一步增加了卒中风险。在 790 名年龄在 30 至 55 岁之间、基线时无 CHA2DS2-VASc 合并症且保持“低风险”的 AF 患者中，即男性 CHA2DS2-VASc 评分为 0，女性为 1，在随访期间，卒中发生率仍明显高于非 AF 患者（1.00/100 人年 vs 0.25/100 人年），经性别调整的风险比为 4.09（95%CI，2.97-5.62）。
本研究发现，当前指南不推荐用于预防血栓栓塞的年轻 AF 患者发生卒中的风险增加。需要更好的卒中风险分层工具，以便优先考虑该人群中年轻的 AF 患者进行血栓预防治疗。
