心房颤动合并急性卒中患者的危险因素、接受的治疗类型及预后的性别差异：RAF研究（急性缺血性卒中和心房颤动患者的早期复发和脑出血）结果
Sex-related differences in risk factors, type of treatment received and outcomes in patients with atrial fibrillation and acute stroke: Results from the RAF-study (Early Recurrence and Cerebral Bleeding in Patients with Acute Ischemic Stroke and Atrial Fibrillation).
作者信息
Antonenko Kateryna, Paciaroni Maurizio, Agnelli Giancarlo, Falocci Nicola, Becattini Cecilia, Marcheselli Simona, Rueckert Christina, Pezzini Alessandro, Poli Loris, Padovani Alessandro, Csiba Laszló, Szabó Lilla, Sohn Sung-Il, Tassinari Tiziana, Abdul-Rahim Azmil H, Michel Patrik, Cordier Maria, Vanacker Peter, Remillard Suzette, Alberti Andrea, Venti Michele, Acciarresi Monica, D'Amore Cataldo, Scoditti Umberto, Denti Licia, Orlandi Giovanni, Chiti Alberto, Gialdini Gino, Bovi Paolo, Carletti Monica, Rigatelli Alberto, Putaala Jukka, Tatlisumak Turgut, Masotti Luca, Lorenzini Gianni, Tassi Rossana, Guideri Francesca, Martini Giuseppe, Tsivgoulis Georgios, Vadikolias Kostantinos, Papageorgiou Sokratis G, Corea Francesco, Sette Massimo Del, Ageno Walter, Lodovici Maria Luisa De, Bono Giorgio, Baldi Antonio, D'Anna Sebastiano, Sacco Simona, Carolei Antonio, Tiseo Cindy, Imberti Davide, Zabzuni Dorjan, Doronin Boris, Volodina Vera, Consoli Domenico, Galati Franco, Pieroni Alessio, Toni Danilo, Monaco Serena, Baronello Mario M, Barlinn Kristian, Pallesen Lars-Peder, Kepplinger Jessica, Bodechtel Ulf, Gerber Johannes, Deleu Dirk, Melikyan Gayane, Ibrahim Faisal, Akhtar Naveed, Mosconi Maria G, Lees Kennedy R, Caso Valeria
机构信息
Department of Neurology, Bogomolets National Medical University, Kyiv, Ukraine.
Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy.
出版信息
Eur Stroke J. 2017 Mar;2(1):46-53. doi: 10.1177/2396987316679577. Epub 2016 Nov 15.
INTRODUCTION
Atrial fibrillation is an independent risk factor of thromboembolism. Women with atrial fibrillation are at a higher overall risk for stroke compared to men with atrial fibrillation. The aim of this study was to evaluate for sex differences in patients with acute stroke and atrial fibrillation, regarding risk factors, treatments received and outcomes.
METHODS
Data were analyzed from the "Recurrence and Cerebral Bleeding in Patients with Acute Ischemic Stroke and Atrial Fibrillation" (RAF-study), a prospective, multicenter, international study including only patients with acute stroke and atrial fibrillation. Patients were followed up for 90 days. Disability was measured by the modified Rankin Scale (0-2 favorable outcome, 3-6 unfavorable outcome).
RESULTS
Of the 1029 patients enrolled, 561 were women (54.5%) ( < 0.001) and younger ( < 0.001) compared to men. In patients with known atrial fibrillation, women were less likely to receive oral anticoagulants before index stroke ( = 0.026) and were less likely to receive anticoagulants after stroke (71.3% versus 78.4%, = 0.01). There was no observed sex difference regarding the time of starting anticoagulant therapy between the two groups (6.4 ± 11.7 days for men versus 6.5 ± 12.4 days for women, = 0.902). Men presented with more severe strokes at onset (mean NIHSS 9.2 ± 6.9 versus 8.1 ± 7.5, < 0.001). Within 90 days, 46 (8.2%) recurrent ischemic events (stroke/TIA/systemic embolism) and 19 (3.4%) symptomatic cerebral bleedings were found in women compared to 30 (6.4%) and 18 (3.8%) in men ( = 0.28 and = 0.74). At 90 days, 57.7% of women were disabled or deceased, compared to 41.1% of the men ( < 0.001). Multivariate analysis did not confirm this significance.
CONCLUSIONS
Women with atrial fibrillation were less likely to receive oral anticoagulants prior to and after stroke compared to men with atrial fibrillation, and when stroke occurred, regardless of the fact that in our study women were younger and with less severe stroke, outcomes did not differ between the sexes.
引言
心房颤动是血栓栓塞的独立危险因素。与患有心房颤动的男性相比，患有心房颤动的女性发生中风的总体风险更高。本研究的目的是评估急性中风合并心房颤动患者在危险因素、接受的治疗及预后方面的性别差异。
方法
对“急性缺血性中风合并心房颤动患者的复发与脑出血”（RAF研究）的数据进行分析，这是一项前瞻性、多中心、国际性研究，仅纳入急性中风合并心房颤动的患者。对患者进行90天的随访。采用改良Rankin量表（0 - 2分为良好预后，3 - 6分为不良预后）评估残疾情况。
结果
在纳入的1029例患者中，女性有561例（54.5%）（P < 0.001），且比男性更年轻（P < 0.001）。在已知患有心房颤动的患者中，女性在首次中风前接受口服抗凝剂治疗的可能性较小（P = 0.026），中风后接受抗凝剂治疗的可能性也较小（71.3%对78.4%，P = 0.01）。两组之间在开始抗凝治疗的时间上未观察到性别差异（男性为6.4±11.7天，女性为6.5±12.4天，P = 0.902）。男性发病时中风更严重（平均美国国立卫生研究院卒中量表[NIHSS]评分9.2±6.9对8.1±7.5，P < 0.001）。在90天内，女性中有46例（8.2%）发生复发性缺血性事件（中风/短暂性脑缺血发作/全身性栓塞），19例（3.4%）出现有症状的脑出血，而男性分别为30例（6.4%）和18例（3.8%）（P = 0.28和P = 0.74）。在90天时，57.7%的女性出现残疾或死亡，而男性为41.1%（P < 0.001）。多因素分析未证实这一显著性差异。
结论
与患有心房颤动的男性相比，患有心房颤动的女性在中风前后接受口服抗凝剂治疗的可能性较小，并且当发生中风时，尽管在我们的研究中女性更年轻且中风程度较轻，但两性之间的预后并无差异。
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