持续性房颤患者二级预防的缺血性事件风险高于阵发性房颤患者。
Higher Risk of Ischemic Events in Secondary Prevention for Patients With Persistent Than Those With Paroxysmal Atrial Fibrillation.
机构信息
From the Division of Stroke Care Unit (M.K., S.A.), Department of Cerebrovascular Medicine (S.Y., M.S., S. Sato, K. Toyoda), and Department of Neurology (H.Y.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan (Y.H.); Department of Neurology, South Miyagi Medical Center, Ogawara, Japan (S. Shibuya); Department of Neurology, Toyota Memorial Hospital, Toyota, Japan (Y.I.); Department of Cerebrovascular Medicine, NHO Kagoshima Medical Center, Kagoshima, Japan (H.M.); Department of Neurology, Ohta Memorial Hospital, Fukuyama, Japan (K. Takamatsu); Department of Neurology, Kitasato University School of Medicine, Sagamihara, Japan (K.N.); Department of Neurology, Kobe City Medical Center General Hospital, Japan (K. Todo); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (K. Kimura, Y.Y.); Department of Stroke Neurology, Kohnan Hospital, Sendai, Japan (E.F.); Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan (T.T.); Departments of Neurosurgery and Stroke Center, Kyorin University School of Medicine, Mitaka, Japan (Y.S.); Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan (K. Kamiyama); Department of Neurology, Tokai University School of Medicine, Isehara, Japan (S.T.); Department of Neurology, NHO Nagoya Medical Center, Nagoya, Japan (S.O.); Department of Neurology and Cerebrovascular Medicine, NHO Kyushu Medical Center, Fukuoka, Japan (Y.O.); Division of Neurology (T.K.) and Division of Cardiovascular Medicine (K. Kario), Jichi Medical University School of Medicine, Shimotsuke, Japan; and Department of Neurology, Kyoto Second Red Cross Hospital, Kyoto, Japan (Y.N.).
出版信息
Stroke. 2016 Oct;47(10):2582-8. doi: 10.1161/STROKEAHA.116.013746. Epub 2016 Aug 16.
BACKGROUND AND PURPOSE
The discrimination between paroxysmal and sustained (persistent or permanent) atrial fibrillation (AF) has not been considered in the approach to secondary stroke prevention. We aimed to assess the differences in clinical outcomes between mostly anticoagulated patients with sustained and paroxysmal AF who had previous ischemic stroke or transient ischemic attack.
METHODS
Using data from 1192 nonvalvular AF patients with acute ischemic stroke or transient ischemic attack who were registered in the SAMURAI-NVAF study (Stroke Management With Urgent Risk-Factor Assessment and Improvement-Nonvalvular AF; a prospective, multicenter, observational study), we divided patients into those with paroxysmal AF and those with sustained AF. We compared clinical outcomes between the 2 groups.
RESULTS
The median follow-up period was 1.8 (interquartile range, 0.93-2.0) years. Of the 1192 patients, 758 (336 women; 77.9±9.9 years old) and 434 (191 women; 77.3±10.0 years old) were assigned to the sustained AF group and paroxysmal AF groups, respectively. After adjusting for sex, age, previous anticoagulation, and initial National Institutes of Health Stroke Scale score, sustained AF was negatively associated with 3-month independence (multivariable-adjusted odds ratio, 0.61; 95% confidence interval, 0.43-0.87; P=0.006). The annual rate of stroke or systemic embolism was 8.3 and 4.6 per 100 person-years, respectively (multivariable-adjusted hazard ratio, 1.95; 95% confidence interval, 1.26-3.14) and that of major bleeding events was 3.4 and 3.1, respectively (hazard ratio, 1.13; 95% confidence interval, 0.63-2.08).
CONCLUSIONS
Among patients with previous ischemic stroke or transient ischemic attack, those with sustained AF had a higher risk of stroke or systemic embolism compared with those with paroxysmal AF.
CLINICAL TRIAL REGISTRATION
URL: http://www.clinicaltrials.gov. Unique identifier: NCT01581502.
背景与目的
在二级预防继发卒中时，阵发性和持续性（持续或永久性）心房颤动（AF）的鉴别并未得到考虑。我们旨在评估先前发生缺血性卒中和短暂性脑缺血发作的、主要接受抗凝治疗的持续性和阵发性 AF 患者之间的临床结局差异。
方法
我们使用来自 SAMURAI-NVAF 研究（卒中介入治疗中的紧急风险因素评估和改善-非瓣膜性房颤；一项前瞻性、多中心、观察性研究）的 1192 例非瓣膜性房颤合并急性缺血性卒中和短暂性脑缺血发作患者的数据，将患者分为阵发性 AF 组和持续性 AF 组。我们比较了两组之间的临床结局。
结果
中位随访时间为 1.8 年（四分位距，0.93-2.0）。在 1192 例患者中，758 例（336 例女性；77.9±9.9 岁）和 434 例（191 例女性；77.3±10.0 岁）分别被分配至持续性 AF 组和阵发性 AF 组。在校正性别、年龄、既往抗凝治疗和初始 NIHSS 评分后，持续性 AF 与 3 个月时的独立性呈负相关（多变量校正优势比，0.61；95%置信区间，0.43-0.87；P=0.006）。卒中或全身性栓塞的年发生率分别为 8.3 和 4.6/100 人年（多变量校正风险比，1.95；95%置信区间，1.26-3.14），大出血事件的年发生率分别为 3.4 和 3.1/100 人年（风险比，1.13；95%置信区间，0.63-2.08）。
结论
在先前发生缺血性卒中和短暂性脑缺血发作的患者中，与阵发性 AF 相比，持续性 AF 发生卒中或全身性栓塞的风险更高。
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