From the Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Faculté de Médecine (A.B., A.B., J.H., N.C., D.B., L.F.), Université François Rabelais, Tours, France.
Service D'Information Médicale et d'Épidémiologie, Centre Hospitalier Universitaire et EA7505 (C.G., J.H.), Université François Rabelais, Tours, France.
Stroke. 2020 Jun;51(6):1674-1681. doi: 10.1161/STROKEAHA.120.029048. Epub 2020 May 11.
Background and Purpose- Atrial fibrillation (AF) is known to increase risk of ischemic stroke (IS), but the risk of IS in isolated sinus node disease (SND) is unclear. We compared the incidence of IS in patients with SND, patients with AF, and in a control population with other cardiac diseases (disease of the circulatory system using the ). Methods- This French longitudinal cohort study was based on the national database covering hospital care for the entire population from 2008 to 2015. Results- Of 1 692 157 patients included in the cohort, 100 366 had isolated SND, 1 564 270 had isolated AF, and 27 521 had AF associated with SND. Incidence of IS during follow-up was higher in isolated patients with AF than in AF associated with SND (yearly rate 2.22% versus 2.06%) and in isolated patients with AF than in isolated patients with SND (yearly rate 2.22% versus 1.59%). The incidence of IS was lower in a control population with other cardiac conditions (n=479 108) compared with SND and patients with AF (0.96%/y, 1.59%/y, and 2.22%/y, respectively). After 1:1 propensity score matching, SND was associated with lower incidence of IS compared to AF (hazard ratio, 0.77 [95% CI, 0.73-0.82]) but higher incidence of IS compared to control population (hazard ratio, 1.27 [95%CI, 1.19-1.35]). Conclusions- Patients with SND had a lower risk of thromboembolic events than patients with AF but a higher risk than a control population with other cardiac diseases. Randomized clinical trial in a selected SND population, with, for example, a high CHADS-VASc score, would be required to determine the value of IS prevention by anticoagulation.
背景与目的-已知心房颤动（AF）会增加缺血性卒中（IS）的风险，但孤立性窦房结疾病（SND）患者发生 IS 的风险尚不清楚。我们比较了 SND 患者、AF 患者和患有其他心脏疾病（心血管疾病）的对照组患者的 IS 发生率。方法-这项法国纵向队列研究基于涵盖 2008 年至 2015 年期间全人群住院治疗的国家数据库。结果-在纳入的 1692157 例患者中，100366 例患者为孤立性 SND，1564270 例患者为孤立性 AF，27521 例患者为 AF 合并 SND。随访期间，孤立性 AF 患者的 IS 发生率高于 AF 合并 SND 患者（年发生率分别为 2.22%和 2.06%），也高于孤立性 SND 患者（年发生率分别为 2.22%和 1.59%）。患有其他心脏疾病（n=479108）的对照组患者的 IS 发生率低于 SND 和 AF 患者（分别为 0.96%/y、1.59%/y 和 2.22%/y）。经 1:1 倾向评分匹配后，SND 患者发生 IS 的风险较 AF 患者低（风险比，0.77[95%CI，0.73-0.82]），但较对照组患者高（风险比，1.27[95%CI，1.19-1.35]）。结论-与 AF 患者相比，SND 患者发生血栓栓塞事件的风险较低，但与患有其他心脏疾病的对照组患者相比，其发生风险较高。需要在选择的 SND 患者人群中开展随机临床试验，例如 CHADS-VASc 评分较高的患者，以确定抗凝预防 IS 的价值。
