Department of Clinical Medicine, K. G. Jebsen Thrombosis Research and Expertise Center, UiT The Arctic University of Norway, Tromsø, Norway
Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway.
J Am Heart Assoc. 2018 Jan 29;7(3):e006502. doi: 10.1161/JAHA.117.006502.
Atrial fibrillation (AF) is a well-established risk factor for ischemic stroke (IS). Emerging evidence also indicates an association between AF and pulmonary embolism (PE). Because IS may potentially mediate the observed risk of PE in AF, we aimed to assess the impact of AF on the cause-specific risks of PE and IS in a large cohort recruited from the general population.
We observed 29 842 participants from 3 surveys of the Tromsø study (inclusion in 1994-1995, 2001-2002, and 2007-2008) to the end of 2012. Incident events of AF, IS, and PE during follow-up were recorded, and information on potential confounders was obtained at baseline. Cox regression models, with AF as a time-dependent variable, were used to calculate cause-specific hazard ratios (HRs) with 95% confidence intervals (CIs) for PE and IS. There were 2067 participants diagnosed as having AF, 296 with PE and 1164 with IS, during a median of 17.6 years of follow-up. The risks of PE (HR, 10.88; 95% CI, 6.23-18.89) and IS (HR, 6.16; 95% CI, 4.47-8.48) were substantially increased during the first 6 months after AF diagnosis, with crude incidence rates of 18.5 per 1000 person-years for PE and 52.8 per 1000 person-years for IS. The risk estimates remained elevated for both PE (HR, 1.72; 95% CI, 1.10-2.71) and IS (HR, 2.45; 95% CI, 2.05-2.92) throughout the study period.
AF was associated with increased cause-specific risks of both PE and IS. Our findings infer that the risk of PE in AF is not explained by intermediate IS.
心房颤动（AF）是缺血性卒中（IS）的一个既定危险因素。新出现的证据也表明 AF 与肺栓塞（PE）之间存在关联。由于 IS 可能潜在地介导 AF 中观察到的 PE 风险，我们旨在评估 AF 对来自一般人群的大型队列中 PE 和 IS 的特定原因风险的影响。
我们观察了 Tromsø 研究的 3 项调查（纳入 1994-1995 年、2001-2002 年和 2007-2008 年）中的 29842 名参与者，随访至 2012 年底。记录随访期间的 AF、IS 和 PE 事件，并在基线时获得潜在混杂因素的信息。使用 Cox 回归模型，以 AF 作为时间依赖性变量，计算 PE 和 IS 的特定原因风险比（HR）和 95%置信区间（CI）。在中位随访 17.6 年期间，有 2067 名参与者被诊断为 AF，296 名参与者患 PE，1164 名参与者患 IS。在 AF 诊断后的前 6 个月，PE（HR，10.88；95%CI，6.23-18.89）和 IS（HR，6.16；95%CI，4.47-8.48）的风险显著增加，PE 的粗发病率为 18.5/1000 人年，IS 的粗发病率为 52.8/1000 人年。整个研究期间，PE（HR，1.72；95%CI，1.10-2.71）和 IS（HR，2.45；95%CI，2.05-2.92）的风险估计值仍保持升高。
AF 与 PE 和 IS 的特定原因风险增加相关。我们的研究结果推断，AF 中的 PE 风险不能用中间的 IS 来解释。
