Henninger Nils, Goddeau Richard P, Karmarkar Ameeta, Helenius Johanna, McManus David D
From the Departments of Neurology (N.H., R.P.G., J.H.), Psychiatry (N.H.), and Internal Medicine (A.K.) and Division of Cardiology, Department of Internal Medicine (D.D.M.), University of Massachusetts Medical School, Worcester.
Stroke. 2016 Jun;47(6):1486-92. doi: 10.1161/STROKEAHA.116.012865. Epub 2016 May 5.
Patients with a cardioembolic stroke (CES) have worse outcomes than stroke patients with other causes of stroke. Among patients with CES, atrial fibrillation (AF) is a common comorbidity. Mounting data indicate that AF may be related to stroke pathogenesis beyond acute cerebral thromboembolism. We sought to determine whether AF represents an independent risk factor for stroke severity and outcome among patients with CES.
We retrospectively analyzed patients with acute hemispheric CES included in an academic medical center's stroke registry. CES was determined using the Causative Classification System of ischemic stroke. Multivariable logistic regression was used to determine whether AF was associated with 90-day outcome functional status.
Our cohort included 140 patients. Of these, 52 had prevalent AF and 28 had incident AF diagnosed during their index hospitalization or within 90 days of hospital discharge. After adjustment for potential confounders or mediators, any AF (odds ratio, 2.51; 95% confidence interval, 1.03-6.33; P=0.049), infarct volume (odds ratio, 1.03; 95% confidence interval, 1.01-1.06; P=0.005), preadmission modified Rankin Scale score (odds ratio, 2.58; 95% confidence interval, 1.66-4.01; P<0.001), and admission National Institutes of Health Stroke Scale score (odds ratio, 1.17; 95% confidence interval, 1.08-1.28; P<0.001) remained associated with an unfavorable 90-day outcome (modified Rankin Scale score, 2-6).
AF is associated with an unfavorable 90-day outcome among patients with a CES independent of established risk factors and initial stroke severity. This suggests that AF-specific mechanisms affect CES severity and functional status after CES. If confirmed in future studies, further investigation into the underlying pathophysiological mechanisms may provide novel avenues to AF detection and treatment.
心源性栓塞性卒中（CES）患者的预后比其他病因所致卒中患者更差。在CES患者中，心房颤动（AF）是一种常见的合并症。越来越多的数据表明，AF可能与急性脑栓塞以外的卒中发病机制有关。我们试图确定AF是否是CES患者卒中严重程度和预后的独立危险因素。
我们回顾性分析了一家学术医疗中心卒中登记处纳入的急性半球性CES患者。使用缺血性卒中病因分类系统确定CES。多变量逻辑回归用于确定AF是否与90天预后功能状态相关。
我们的队列包括140名患者。其中，52例有既往AF，28例在其首次住院期间或出院后90天内诊断为新发AF。在对潜在混杂因素或中介因素进行调整后，任何AF（比值比，2.51；95%置信区间，1.03 - 6.33；P = 0.049）、梗死体积（比值比，1.03；95%置信区间，1.01 - 1.06；P = 0.005）、入院前改良Rankin量表评分（比值比，2.58；95%置信区间，1.66 - 4.01；P < 0.001）和入院时美国国立卫生研究院卒中量表评分（比值比，1.17；95%置信区间，1.08 - 1.28；P < 0.001）仍与不良90天预后（改良Rankin量表评分，2 - 6）相关。
AF与CES患者不良90天预后相关，独立于既定危险因素和初始卒中严重程度。这表明AF特异性机制影响CES严重程度和CES后的功能状态。如果在未来研究中得到证实，对潜在病理生理机制的进一步研究可能为AF的检测和治疗提供新途径。
