Eun Mi-Yeon, Kim Jae-Young, Hwang Yang-Ha, Park Man-Seok, Kim Joon-Tae, Choi Kang-Ho, Jung Jin-Man, Yu Sungwook, Kim Chi Kyung, Oh Kyungmi, Song Tae-Jin, Kim Yong-Jae, Kim Bum Joon, Heo Sung Hyuk, Park Kwang-Yeol, Kim Jeong-Min, Park Jong-Ho, Choi Jay Chol, Chung Jong-Won, Bang Oh Young, Kim Gyeong-Moon, Seo Woo-Keun
Department of Neurology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.
Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Stroke. 2021 Jan;23(1):113-123. doi: 10.5853/jos.2020.03440. Epub 2021 Jan 31.
To evaluate the outcome events and bleeding complications of the European Society of Cardiology (ESC) guideline-matched oral anticoagulant therapy for patients with acute ischemic stroke and atrial fibrillation (AF).
Patients with acute ischemic stroke and AF from a nationwide multicenter registry (Korean ATrial fibrillaTion EvaluatioN regisTry in Ischemic strOke patieNts [K-ATTENTION]) between January 2013 and December 2015 were included in the study. Patients were divided into the ESC guideline-matched and the non-matched groups. The primary outcome was recurrence of any stroke during the 90-day follow-up period. Secondary outcomes were major adverse cerebrovascular and cardiovascular events, ischemic stroke, intracranial hemorrhage, acute coronary syndrome, allcause mortality, and major hemorrhage. Propensity score matching and logistic regression analyses were performed to assess the effect of the treatments administered.
Among 2,321 eligible patients, 1,126 patients were 1:1 matched to the ESC guidelinematched and the non-matched groups. As compared with the non-matched group, the ESC guideline-matched group had a lower risk of any recurrent stroke (1.4% vs. 3.4%; odds ratio [OR], 0.41; 95% confidence interval [CI], 0.18 to 0.95). The risk of recurrent ischemic stroke was lower in the ESC guideline-matched group than in the non-matched group (0.9% vs. 2.7%; OR, 0.32; 95% CI, 0.11 to 0.88). There was no significant difference in the other secondary outcomes between the two groups.
ESC guideline-matched oral anticoagulant therapy was associated with reduced risks of any stroke and ischemic stroke as compared with the non-matched therapy.
评估欧洲心脏病学会（ESC）指南匹配的口服抗凝治疗对急性缺血性卒中合并心房颤动（AF）患者的结局事件及出血并发症。
纳入2013年1月至2015年12月来自全国多中心登记处（韩国急性缺血性卒中患者心房颤动评估登记处[K-ATTENTION]）的急性缺血性卒中和AF患者。患者分为ESC指南匹配组和非匹配组。主要结局为90天随访期内任何卒中的复发。次要结局为主要不良脑血管和心血管事件、缺血性卒中、颅内出血、急性冠状动脉综合征、全因死亡率和大出血。进行倾向评分匹配和逻辑回归分析以评估所给予治疗的效果。
在2321例符合条件的患者中，1126例患者按1:1比例匹配至ESC指南匹配组和非匹配组。与非匹配组相比，ESC指南匹配组任何复发性卒中的风险较低（1.4%对3.4%；比值比[OR]，0.41；95%置信区间[CI]，0.18至0.95）。ESC指南匹配组复发性缺血性卒中的风险低于非匹配组（0.9%对2.7%；OR，0.32；95%CI，0.11至0.88）。两组间其他次要结局无显著差异。
与非匹配治疗相比，ESC指南匹配的口服抗凝治疗与任何卒中和缺血性卒中风险降低相关。
