中风后检测到的心房颤动与缺血性中风复发的低风险相关。

Atrial fibrillation detected after stroke is related to a low risk of ischemic stroke recurrence.

机构信息

From the Department of Clinical Neurological Sciences, London Health Sciences Centre (L.A.S., S.F.), Department of Anatomy and Cell Biology (L.A.S.), and Department of Epidemiology and Biostatistics (L.A.S., J.O.C., L.E.C.), Schulich School of Medicine and Dentistry, Stroke, Dementia, and Heart Disease Lab (L.A.S., M.P.), and Ivey Business School (L.E.C.), Western University, London; Institute for Clinical Evaluative Sciences (J.F., G.S.), Toronto; Stroke Outcomes & Decision Neuroscience Research Unit (G.S.), Division of Neurology, Department of Medicine, St. Michael's Hospital and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, Institute for Clinical Evaluative Sciences, University of Toronto; and Li Ka Shing Knowledge Institute (G.S.), Toronto, Canada.

出版信息

Neurology. 2018 Mar 13;90(11):e924-e931. doi: 10.1212/WNL.0000000000005126. Epub 2018 Feb 14.

DOI:10.1212/WNL.0000000000005126

PMID:29444969

Abstract

OBJECTIVE

To compare the risk of 1-year ischemic stroke recurrence between atrial fibrillation (AF) diagnosed after stroke (AFDAS) and sinus rhythm (SR) and investigate whether underlying heart disease is as frequent in AFDAS as it is in AF known before stroke (KAF).

METHODS

In this retrospective cohort study, we included all ischemic stroke patients admitted to institutions participating in the Ontario Stroke Registry from July 1, 2003, to March 31, 2013. Based on heart rhythm assessed during admission, we classified patients as AFDAS, KAF, or SR. We modeled the relationship between heart rhythm groups and 1-year ischemic stroke recurrence by using Cox regression adjusted for multiple covariates (e.g., oral anticoagulants). We compared the prevalence of coronary artery disease, myocardial infarction, and heart failure among the 3 groups.

RESULTS

Among 23,376 ischemic stroke patients, 15,885 had SR, 587 AFDAS, and 6,904 KAF. At 1 year, 39 (6.6%) patients with AFDAS, 661 (9.6%) with KAF, and 1,269 (8.0%) with SR had recurrent ischemic strokes ( = 0.0001). AFDAS-related ischemic stroke recurrence adjusted risk was not different from that of SR (hazard ratio 0.90 [95% confidence interval 0.63, 1.30]; = 0.57). Prevalence of coronary artery disease (18.2% vs 34.7%; < 0.0001), myocardial infarction (11.6% vs 20.5%; < 0.0001), and heart failure (5.5% vs 16.8%; < 0.0001) were lower in AFDAS relative to KAF.

CONCLUSIONS

The lack of difference in 1-year ischemic stroke recurrence between AFDAS and SR and the lower prevalence of heart disease in AFDAS compared to KAF suggest that the underlying pathophysiology of AFDAS may differ from that of KAF.

摘要

目的

比较经卒中诊断的心房颤动（AFDAS）与窦性节律（SR）患者 1 年内缺血性卒中复发风险，并探讨潜在心脏病在 AFDAS 中的发生频率是否与卒中前已知的心房颤动（KAF）相同。

方法

本回顾性队列研究纳入了 2003 年 7 月 1 日至 2013 年 3 月 31 日期间参与安大略卒中登记处的各机构收治的所有缺血性卒中患者。根据入院时评估的心律情况，将患者分为 AFDAS、KAF 或 SR。我们采用 Cox 回归模型对经过多变量调整后的心律组与 1 年内缺血性卒中复发的关系进行建模（例如，口服抗凝剂）。我们比较了 3 组之间冠心病、心肌梗死和心力衰竭的患病率。

结果

在 23376 例缺血性卒中患者中，15885 例为 SR，587 例为 AFDAS，6904 例为 KAF。在 1 年时，39 例（6.6%）AFDAS 患者、661 例（9.6%）KAF 患者和 1269 例（8.0%）SR 患者发生了复发性缺血性卒中（=0.0001）。AFDAS 相关缺血性卒中复发的调整风险与 SR 无差异（风险比 0.90[95%置信区间 0.63，1.30]；=0.57）。与 KAF 相比，AFDAS 中冠心病（18.2% vs. 34.7%；<0.0001）、心肌梗死（11.6% vs. 20.5%；<0.0001）和心力衰竭（5.5% vs. 16.8%；<0.0001）的患病率较低。