Kim Jae Guk, Lee Young Soo, Kang Ki-Woon, Choi Eue-Keun, Cha Myung-Jin, Lee Jung-Myung, Kim Jin-Bae, Park Junbeom, Park Jin-Kyu, Kim Tae-Hoon, Uhm Jae-Sun, Shim Jaemin, Kim Jun, Park HyungWook, Kim Changsoo, Joung Boyoung
Department of Neurology, Eulji University Hospital, Daejeon, Korea.
Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea.
Korean J Intern Med. 2021 Jan;36(1):114-123. doi: 10.3904/kjim.2019.063. Epub 2019 Oct 14.
BACKGROUND/AIMS: Comparative occurrence of ischemic stroke for rhythm versus rate control strategy in patients with non-valvular atrial fibrillation (NVAF) is still inconclusive. The purpose of this study was to investigate whether the rhythm control strategy is associated with a lower risk of ischemic stroke compared to the rate control strategy in NVAF patients.
The CODE-AF registry prospectively enrolled 6,280 consecutive patients who were treated for NVAF at 10 tertiary referral centers in South Korea. Of these, 2,513 NVAF patients (age, 67 ± 10 years; male, 61.8%) were clinically followed up for over 1-year and divided into rate and rhythm control groups.
Those treated with the rhythm control strategy were younger and had less proportions of underlying disease compared to those treated with the rate control strategy. After the propensity matching analysis, those treated with the rhythm control strategy had similar baseline characteristics including the CHA2DS2-VASC score compared to those treated with the rate control strategy. The rate of oral anticoagulation, all bleeding, and hospitalization were also similarly between the two groups. The incidence rate of ischemic stroke in the rhythm control group was significantly lower than in the rate control group (0.7 vs. 6.9 per 1,000 person-years, p = 0.011).
The rhythm control strategy demonstrated a beneficial effect to lower the risk of ischemic stroke during a 1-year follow-up compared to the rate control strategy.
背景/目的：在非瓣膜性心房颤动（NVAF）患者中，节律控制与心率控制策略相比，缺血性卒中的相对发生率仍无定论。本研究的目的是调查在NVAF患者中，与心率控制策略相比，节律控制策略是否与较低的缺血性卒中风险相关。
CODE-AF注册研究前瞻性纳入了韩国10家三级转诊中心连续治疗的6280例NVAF患者。其中，2513例NVAF患者（年龄67±10岁；男性占61.8%）进行了超过1年的临床随访，并分为心率控制组和节律控制组。
与接受心率控制策略治疗的患者相比，接受节律控制策略治疗的患者更年轻，基础疾病比例更低。倾向匹配分析后，与接受心率控制策略治疗的患者相比，接受节律控制策略治疗的患者具有相似的基线特征，包括CHA2DS2-VASC评分。两组的口服抗凝率、所有出血率和住院率也相似。节律控制组的缺血性卒中发生率显著低于心率控制组（每1000人年0.7例 vs. 6.9例，p = 0.011）。
与心率控制策略相比，节律控制策略在1年随访期间显示出降低缺血性卒中风险的有益效果。
