Kim Bum Joon, 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, Park Kwang-Yeol, Kim Jeong-Min, Park Jong-Ho, Choi Jay Chol, Chung Jong-Won, Bang Oh Young, Kim Gyeong-Moon, Heo Sung Hyuk, Seo Woo-Keun
Department of Neurology, Asan Medical Center, Seoul, South Korea.
Department of Neurology, Kyungpook National University Hospital, Daegu, South Korea.
Front Neurol. 2021 Oct 21;12:744607. doi: 10.3389/fneur.2021.744607. eCollection 2021.
Ischemic stroke with atrial fibrillation (AF) may recur despite appropriate treatment. It may be AF-related or AF-unrelated. We compared the factors associated with AF-related and AF-unrelated recurrences among ischemic stroke patients with AF. Patients with ischemic stroke and AF were enrolled from 11 centers in Korea. Ischemic stroke recurrence was classified as AF-related if the lesion pattern was compatible with cardioembolism without significant stenosis or as AF-unrelated if the lesion was more likely due to small vessel disease or arterial stenosis. Factors associated with stroke recurrence (AF-related and AF-unrelated) were investigated. Among the 2,239 patients, 115 (5.1%) experienced recurrence (75 AF-related and 40 AF-unrelated). Factors independently associated with any stroke recurrence included AF diagnosed before stroke, small subcortical infarctions, and small scattered lesions in a single vascular territory. Type of AF was associated with the type of stroke recurrence, with persistent AF being associated with AF-related stroke [hazard ratio (HR) = 2.94, 95% confidence interval (CI) 1.69-5.26; < 0.001]. By contrast, paroxysmal AF (HR = 3.76, 95% CI 1.56-9.04; = 0.003), AF diagnosed before stroke (HR = 2.38, 95% CI 1.19-4.55; = 0.014), small scattered lesions in a single vascular territory (reference: corticosubcortical lesion, HR = 3.19, 95% CI 1.18-8.63; = 0.022), and the use of antiplatelet agents (HR = 2.11, 95% CI 1.11-4.03; = 0.024) were independently associated with AF-unrelated stroke. Persistent AF was more associated with AF-related stroke recurrence, whereas paroxysmal AF was more associated with AF-unrelated stroke recurrence. A scattered lesion in a single vascular territory may predict AF-unrelated stroke recurrence.
伴有心房颤动（AF）的缺血性卒中即便接受了恰当治疗仍可能复发。复发可能与房颤相关，也可能与房颤无关。我们比较了伴有房颤的缺血性卒中患者中与房颤相关及与房颤无关的复发因素。韩国11个中心纳入了患有缺血性卒中和房颤的患者。如果病变模式符合无明显狭窄的心源性栓塞，则缺血性卒中复发被归类为与房颤相关；如果病变更可能是由小血管疾病或动脉狭窄所致，则归类为与房颤无关。研究了与卒中复发（与房颤相关和与房颤无关）相关的因素。在2239例患者中，115例（5.1%）出现复发（75例与房颤相关，40例与房颤无关）。与任何卒中复发独立相关的因素包括卒中前诊断出房颤、小的皮质下梗死以及单一血管区域内的小的散在病变。房颤类型与卒中复发类型相关，持续性房颤与房颤相关的卒中有关[风险比（HR）=2.94，95%置信区间（CI）1.69 - 5.26；P<0.001]。相比之下，阵发性房颤（HR = 3.76，95% CI 1.56 - 9.04；P = 0.003）、卒中前诊断出房颤（HR = 2.38，95% CI 1.19 - 4.55；P = 0.014）、单一血管区域内的小的散在病变（参照：皮质 - 皮质下病变，HR = 3.19，95% CI 1.18 - 8.63；P = 0.022）以及使用抗血小板药物（HR = 2.11，95% CI 1.11 - 4.03；P = 0.024）与房颤无关的卒中独立相关。持续性房颤与房颤相关的卒中复发关联更大，而阵发性房颤与房颤无关的卒中复发关联更大。单一血管区域内的散在病变可能预示着房颤无关的卒中复发。
