Second Department of Neurology, "Attikon" University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada.
Ann Neurol. 2020 Nov;88(5):946-955. doi: 10.1002/ana.25886. Epub 2020 Sep 4.
In this study, we sought to evaluate the impact of implantable cardiac monitoring (ICM) in the prevention of stroke recurrence after a cryptogenic ischemic stroke or transient ischemic attack (TIA).
We evaluated consecutive patients with cryptogenic ischemic stroke or TIA admitted in a comprehensive stroke center during an 8-year period. We compared the baseline characteristics and outcomes between patients receiving conventional cardiac monitoring with repeated 24-hour Holter-monitoring during the first 5 years in the outpatient setting and those receiving continuous cardiac monitoring with ICM during the last 3 years. Associations on the outcomes of interest were further assessed in multivariable regression models adjusting for potential confounders.
We identified a total of 373 patients receiving conventional cardiac monitoring and 123 patients receiving ICM. Paroxysmal atrial fibrillation (PAF) detection was higher in the ICM cohort compared to the conventional cardiac monitoring cohort (21.1% vs 7.5%, p < 0.001). ICM was independently associated with an increased likelihood of PAF detection during follow-up (hazard ratio [HR] = 1.94, 95% confidence interval [CI] = 1.16-3.24) in multivariable analyses. Patients receiving ICM were also found to have significantly higher rates of anticoagulation initiation (18.7% vs 6.4%, p < 0.001) and lower risk of stroke recurrence (4.1% vs 11.8%, p = 0.013). ICM was independently associated with a lower risk of stroke recurrence during follow-up (HR = 0.32, 95% CI = 0.11-0.90) in multivariable analyses.
ICM appears to be independently associated with a higher likelihood of PAF detection and anticoagulation initiation after a cryptogenic ischemic stroke or TIA. ICM was also independently related to lower risk of stroke recurrence in our cryptogenic stroke / TIA cohort. ANN NEUROL 2020;88:946-955.
本研究旨在评估植入式心脏监测（ICM）在预防隐源性缺血性卒中和短暂性脑缺血发作（TIA）后卒中复发中的作用。
我们评估了 8 年内连续入住综合卒中中心的隐源性缺血性卒中和 TIA 患者。我们比较了在门诊进行的前 5 年期间接受常规心脏监测（重复 24 小时动态心电图监测）和在最后 3 年期间接受连续心脏监测（ICM）的患者的基线特征和结局。在多变量回归模型中，调整潜在混杂因素后，进一步评估了与感兴趣结局相关的关联。
我们共纳入了 373 例接受常规心脏监测的患者和 123 例接受 ICM 的患者。ICM 组阵发性心房颤动（PAF）的检出率明显高于常规心脏监测组（21.1% vs. 7.5%，p<0.001）。多变量分析显示，ICM 与随访期间 PAF 检出率的增加独立相关（危险比[HR]=1.94，95%置信区间[CI]：1.16-3.24）。接受 ICM 的患者也发现抗凝治疗的起始率显著更高（18.7% vs. 6.4%，p<0.001），卒中复发的风险显著更低（4.1% vs. 11.8%，p=0.013）。多变量分析显示，ICM 与随访期间卒中复发风险的降低独立相关（HR=0.32，95%CI：0.11-0.90）。
ICM 似乎与隐源性缺血性卒中和 TIA 后 PAF 检出率和抗凝治疗的起始率的增加独立相关。在我们的隐源性卒中和 TIA 队列中，ICM 也与卒中复发风险的降低独立相关。
