心房颤动相关性卒中的全球发病率调查：不明来源栓塞性卒中全球注册研究
Global Survey of the Frequency of Atrial Fibrillation-Associated Stroke: Embolic Stroke of Undetermined Source Global Registry.
作者信息
Perera Kanjana S, Vanassche Thomas, Bosch Jackie, Swaminathan Balakumar, Mundl Hardi, Giruparajah Mohana, Barboza Miguel A, O'Donnell Martin J, Gomez-Schneider Maia, Hankey Graeme J, Yoon Byung-Woo, Roxas Artemio, Lavallee Philippa, Sargento-Freitas Joao, Shamalov Nikolay, Brouns Raf, Gagliardi Rubens J, Kasner Scott E, Pieroni Alessio, Vermehren Philipp, Kitagawa Kazuo, Wang Yongjun, Muir Keith, Coutinho Jonathan M, Connolly Stuart J, Hart Robert G
机构信息
From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la Infancia (FLENI), Buenos Aires, Argentina (M.G.-S.); School of Medicine and Pharmacology, University of Western Australia, Sir Charles Gairdner Hospital, Perth, Australia (G.J.H.); Department of Neurology, Seoul National University Hospital, Korea (B.-W.Y.); Medical City Hospital, Manila, Philippines (A.R.); Department of Neurology, Bichat Hospital, Paris, France (P.L.); Centro Hospitalar e Universitário de Coimbra, Portugal (J.S.-F.); Pirogov Russian National Research Medical University, Moscow, Russia (N.S.); Universitair Ziekenhuis Brussel, Belgium (R.B.); Santa Casa de São Paulo, Medical School, Brazil (R.J.G.); Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia (S.E.K.); Emergency Department Stroke Unit, Hospital Policlinico Umberto I, Department of Neurology and Psychiatry, 'Sapienza' University, Rome, Italy (A.P.); Department of Neurology, University Hospital Heidelberg, Germany (P.V.); Department of Neurology, Tokyo Women's Medical University, Japan (K.K.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (Y.W.); Institute of Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (K.M.); and Academic Medical Center, Amsterdam, the Netherlands (J.M.C.).
出版信息
Stroke. 2016 Sep;47(9):2197-202. doi: 10.1161/STROKEAHA.116.013378. Epub 2016 Aug 9.
BACKGROUND AND PURPOSE
Atrial fibrillation (AF) is increasingly recognized as the single most important cause of disabling ischemic stroke in the elderly. We undertook an international survey to characterize the frequency of AF-associated stroke, methods of AF detection, and patient features.
METHODS
Consecutive patients hospitalized for ischemic stroke in 2013 to 2014 were surveyed from 19 stroke research centers in 19 different countries. Data were analyzed by global regions and World Bank income levels.
RESULTS
Of 2144 patients with ischemic stroke, 590 (28%; 95% confidence interval, 25.6-29.5) had AF-associated stroke, with highest frequencies in North America (35%) and Europe (33%) and lowest in Latin America (17%). Most had a history of AF before stroke (15%) or newly detected AF on electrocardiography (10%); only 2% of patients with ischemic stroke had unsuspected AF detected by poststroke cardiac rhythm monitoring. The mean age and 30-day mortality rate of patients with AF-associated stroke (75 years; SD, 11.5 years; 10%; 95% confidence interval, 7.6-12.6, respectively) were substantially higher than those of patients without AF (64 years; SD, 15.58 years; 4%; 95% confidence interval, 3.3-5.4; P<0.001 for both comparisons). There was a strong positive correlation between the mean age and the frequency of AF (r=0.76; P=0.0002).
CONCLUSIONS
This cross-sectional global sample of patients with recent ischemic stroke shows a substantial frequency of AF-associated stroke throughout the world in proportion to the mean age of the stroke population. Most AF is identified by history or electrocardiography; the yield of conventional short-duration cardiac rhythm monitoring is relatively low. Patients with AF-associated stroke were typically elderly (>75 years old) and more often women.
背景与目的
心房颤动（AF）日益被认为是老年人致残性缺血性卒中的最重要单一病因。我们开展了一项国际调查，以描述与AF相关的卒中的发生率、AF检测方法及患者特征。
方法
对来自19个不同国家的19个卒中研究中心在2013年至2014年期间因缺血性卒中住院的连续患者进行调查。数据按全球区域和世界银行收入水平进行分析。
结果
在2144例缺血性卒中患者中，590例（28%；95%置信区间为25.6 - 29.5）发生了与AF相关的卒中，北美（35%）和欧洲（33%）的发生率最高，拉丁美洲（17%）最低。大多数患者在卒中前有AF病史（15%）或在心电图检查时新发现AF（10%）；仅有2%的缺血性卒中患者通过卒中后心律监测发现了未被怀疑的AF。与AF相关的卒中患者的平均年龄（75岁；标准差，11.5岁）和30天死亡率（10%；95%置信区间为7.6 - 12.6）显著高于无AF的患者（64岁；标准差，15.58岁；4%；95%置信区间为3.3 - 5.4；两项比较P均<0.001）。平均年龄与AF发生率之间存在强正相关（r = 0.76；P = 0.0002）。
结论
这项近期缺血性卒中患者的横断面全球样本显示，全球范围内与AF相关的卒中发生率与卒中人群的平均年龄成比例，且相当可观。大多数AF通过病史或心电图检查得以识别；传统短程心律监测的检出率相对较低。与AF相关的卒中患者通常为老年人（>75岁），且女性更为常见。
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