Mac Grory Brian, Landman Sean R, Ziegler Paul D, Boisvert Chantal J, Flood Shane P, Stretz Christoph, Madsen Tracy E, Reznik Michael E, Cutting Shawna, Moore Elizabeth E, Hewitt Hunter, Closser James B, Torres Jose, Lavin Patrick J, Furie Karen L, Xian Ying, Feng Wayne, Biousse Valérie, Schrag Matthew, Yaghi Shadi
Departments of Neurology (B.M.G., Y.X., W.F.), Duke University School of Medicine, Durham, NC.
Medtronic plc, Minneapolis, MN (S.R.L., P.D.Z.).
Stroke. 2021 Aug;52(9):2773-2781. doi: 10.1161/STROKEAHA.120.033934. Epub 2021 Jun 7.
Central retinal artery occlusion (CRAO) causes sudden, irreversible blindness and is a form of acute ischemic stroke. In this study, we sought to determine the proportion of patients in whom atrial fibrillation (AF) is detected by extended cardiac monitoring after CRAO.
We performed a retrospective, observational cohort study using data from the Optum deidentified electronic health record of 30.8 million people cross-referenced with the Medtronic CareLink database of 2.7 million people with cardiac monitoring devices in situ. We enrolled patients in 3 groups: (1) CRAO, (2) cerebral ischemic stroke, and (3) age-, sex-, and comorbidity-matched controls. The primary end point was the detection of new AF (defined as ≥2 minutes of AF detected on a cardiac monitoring device).
We reviewed 884 431 patient records in common between the two databases to identify 100 patients with CRAO, 6559 with ischemic stroke, and 1000 matched controls. After CRAO, the cumulative incidence of new AF at 2 years was 49.6% (95% CI, 37.4%–61.7%). Patients with CRAO had a higher rate of AF than controls (hazard ratio, 1.64 [95% CI, 1.17–2.31]) and a comparable rate to patients with stroke (hazard ratio, 1.01 [95% CI, 0.75–1.36]). CRAO was associated with a higher incidence of new stroke compared with matched controls (hazard ratio, 2.85 [95% CI, 1.29–6.29]).
The rate of AF detection after CRAO is higher than that seen in age-, sex-, and comorbidity-matched controls and comparable to that seen after ischemic cerebral stroke. Paroxysmal AF should be considered as part of the differential etiology of CRAO, and those patients may benefit from long-term cardiac monitoring.
视网膜中央动脉阻塞（CRAO）可导致突然的、不可逆的失明，是急性缺血性卒中的一种形式。在本研究中，我们试图确定CRAO后通过延长心脏监测检测到心房颤动（AF）的患者比例。
我们进行了一项回顾性观察队列研究，使用来自Optum的3080万人去识别化电子健康记录的数据，并与美敦力CareLink数据库中270万植入心脏监测设备的人员数据进行交叉参考。我们将患者分为3组：（1）CRAO组，（2）脑缺血性卒中组，（3）年龄、性别和合并症匹配的对照组。主要终点是检测到新发房颤（定义为在心脏监测设备上检测到≥2分钟的房颤）。
我们审查了两个数据库中共有的884431份患者记录，以识别出100例CRAO患者、6559例缺血性卒中患者和1000例匹配的对照组。CRAO后，2年时新发房颤的累积发生率为49.6%（95%CI，37.4%–61.7%）。CRAO患者的房颤发生率高于对照组（风险比，1.64[95%CI，1.17–2.31]），与卒中患者的发生率相当（风险比，1.01[95%CI，0.75–1.36]）。与匹配的对照组相比，CRAO与新发卒中的发生率较高相关（风险比，2.85[95%CI，1.29–6.29]）。
CRAO后房颤的检测率高于年龄、性别和合并症匹配的对照组，与缺血性脑卒中后的检测率相当。阵发性房颤应被视为CRAO鉴别病因的一部分，这些患者可能从长期心脏监测中获益。
