Dahal Khagendra, Chapagain Bikas, Maharjan Raju, Farah Hussam W, Nazeer Ayesha, Lootens Robert J, Rosenfeld Alan
Department of Medicine, LRG Healthcare, Laconia, NH.
Division of Neurology, Nanticoke Memorial Hospital, Seaford, DE.
Ann Noninvasive Electrocardiol. 2016 Jul;21(4):382-8. doi: 10.1111/anec.12319. Epub 2015 Nov 2.
The cause of ischemic stroke or transient ischemic attack (TIA) remains unclear after initial cardiac monitoring in approximately one-third of patients. Randomized controlled trials (RCTs) showed that the prolonged cardiac monitoring of patients with cryptogenic stroke or TIA increased detection of atrial fibrillation (AF). We aimed to perform a meta-analysis of all RCTs that evaluated the prolonged monitoring ≥7 days in patients with cryptogenic stroke or TIA.
We searched PubMed, EMBASE, Cochrane CENTRAL, and relevant references for RCTs without language restriction (inception through December 2014) and performed meta-analysis using random effects model. Detection of AF, use of anticoagulation at follow-up, recurrent stroke or TIA, and mortality were major outcomes.
Four RCTs with 1149 total patients were included in the meta-analysis. Prolonged cardiac monitoring ≥7 days compared to shorter cardiac monitoring of ≤48 hours duration increased the detection of AF (≥30 seconds duration) in patients after cryptogenic stroke or TIA (13.8% vs. 2.5%; odds ratio [OR], 6.4; 95% confidence interval [CI], 3.50-11.73; P < 0.00001; I(2) , 0%]. It also increased the odds of AF detection of any duration (22.6% vs. 5.2%; 5.68[3.3-9.77]; P < 0.00001; I(2) , 0%). The patients who underwent prolonged monitoring were more likely to be on anticoagulation at follow-up (2.21[1.52-3.21]; P < 0.0001; I(2) , 0%). No differences in recurrent stroke or TIA (0.78[0.40-1.55]; P = 0.48; I(2) , 0%) and mortality (1.33[0.29-6.00]; P = 0.71; I(2) , 0%] were observed between two strategies.
Prolonged cardiac monitoring improves detection of atrial fibrillation and anti-coagulation use after cryptogenic stroke or TIA and therefore should be considered instead of shorter duration of cardiac monitoring.
在大约三分之一的患者中，经过初始心脏监测后，缺血性中风或短暂性脑缺血发作（TIA）的病因仍不明确。随机对照试验（RCT）表明，对隐源性中风或TIA患者进行延长心脏监测可增加房颤（AF）的检出率。我们旨在对所有评估对隐源性中风或TIA患者进行≥7天延长监测的RCT进行荟萃分析。
我们检索了PubMed、EMBASE、Cochrane CENTRAL以及相关参考文献，以查找无语言限制的RCT（从创刊至2014年12月），并使用随机效应模型进行荟萃分析。主要结局包括房颤的检出、随访时抗凝治疗的使用、复发性中风或TIA以及死亡率。
荟萃分析纳入了4项RCT，共1149例患者。与≤48小时的较短心脏监测相比，对隐源性中风或TIA患者进行≥7天的延长心脏监测增加了房颤（持续时间≥30秒）的检出率（13.8%对2.5%；优势比[OR]为6.4；95%置信区间[CI]为3.50 - 11.73；P < 0.00001；I²为0%）。它还增加了任何持续时间房颤的检出几率（22.6%对5.2%；5.68[3.3 - 9.77]；P < 0.00001；I²为0%）。接受延长监测的患者在随访时更有可能接受抗凝治疗（2.21[1.52 - 3.21]；P < 0.0001；I²为0%）。两种策略在复发性中风或TIA（0.78[0.40 - 1.55]；P = 0.48；I²为0%）和死亡率（1.33[0.29 - 6.00]；P = 0.71；I²为0%）方面未观察到差异。
延长心脏监测可提高隐源性中风或TIA后房颤的检出率及抗凝治疗的使用率，因此应考虑采用延长心脏监测而非较短时间的心脏监测。
