Chiang Cheng-Hung, Hung Wan-Ting, Huang Wei-Chun, Jheng Ying-Chun, Lai Wei-Yi, Lin Yi-Ying, Lin Tzu-Wei, Lin Kun-Chang, Cheng Chin-Chang, Kuo Feng-Yu
Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC.
School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2021 Dec 1;84(12):1126-1134. doi: 10.1097/JCMA.0000000000000631.
Acute myocardial infarction (AMI) and atrial fibrillation (AF) are risk factors for stroke. The risk of stroke after AMI may differ between patients with and without AF. The aim of this study was to evaluate the impact of AF on stroke in patients after the first AMI.
This was a retrospective, nationwide cohort study. Patients with a primary diagnosis of a first AMI between 2000 and 2012 were included. All patients were followed up until ischemic stroke or transient ischemic attack (TIA), or December 31, 2012, whichever occurred first. Kaplan-Meier cumulative survival curves were constructed to compare ischemic stroke or TIA between AMI patients with and without AF.
A total of 170 472 patients were enrolled in this study. Among them, 8530 patients with AF were identified. The propensity score matching technique was used to match 8530 patients without AF of similar ages and sexes. Overall, the 12-year stroke rate was significantly higher in patients with AF than in those without AF (log-rank p < 0.001), including different sexes, ages, and interventional therapy subgroups. Patients with pre-existing AF had higher stroke rates than those with newly diagnosed AF in male sex, age below 65 years, and those receiving interventional therapy subgroups. In Cox proportional-hazard regression analysis, AF was an independent risk factor for stroke after the first AMI (hazard ratio, 1.67; 95% CI: 1.5-1.87).
AF significantly increases stroke risk after the first AMI. In patients with AF, those with pre-existing AF have higher stroke risks in male sex, age below 65 years, and those with interventional therapy than those with newly diagnosed AF.
急性心肌梗死（AMI）和心房颤动（AF）是中风的危险因素。AMI后中风的风险在有和没有AF的患者中可能有所不同。本研究的目的是评估AF对首次AMI后患者中风的影响。
这是一项回顾性的全国性队列研究。纳入2000年至2012年间初次诊断为首次AMI的患者。所有患者均随访至发生缺血性中风或短暂性脑缺血发作（TIA），或2012年12月31日，以先发生者为准。构建Kaplan-Meier累积生存曲线以比较有和没有AF的AMI患者之间的缺血性中风或TIA情况。
本研究共纳入170472例患者。其中，识别出8530例AF患者。采用倾向评分匹配技术匹配8530例年龄和性别相似的无AF患者。总体而言，AF患者的12年中风发生率显著高于无AF患者（对数秩检验p<0.001），包括不同性别、年龄和介入治疗亚组。在男性、65岁以下年龄组以及接受介入治疗的亚组中，既往有AF的患者中风发生率高于新诊断为AF的患者。在Cox比例风险回归分析中，AF是首次AMI后中风的独立危险因素（风险比，1.67；95%CI：1.5-1.87）。
AF显著增加首次AMI后的中风风险。在AF患者中，男性、65岁以下年龄组以及接受介入治疗的患者中，既往有AF的患者比新诊断为AF的患者中风风险更高。
