房颤患者电复律的频率与中风风险的相关性：FinCV-4 研究。
Frequency of cardioversions as an additional risk factor for stroke in atrial fibrillation - the FinCV-4 study.
机构信息
Heart Center, Turku University Hospital and University of Turku, Turku, Finland.
Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
出版信息
Ann Med. 2022 Dec;54(1):1452-1458. doi: 10.1080/07853890.2022.2077430.
BACKGROUND
Patients with atrial fibrillation (AF) are selected for oral anticoagulation based on individual patient characteristics. There is little information on how clinical AF burden associates with the risk of ischaemic stroke or systemic embolism (SSE). The aim of this study was to explore the association of the frequency of cardioversions (CV) as a measure of clinical AF burden on the long-term SSE risk, with a focus on patients at intermediate stroke risk based on CHADS-VASc score. For these patients, additional SSE risk stratification by assessing CV frequency may aid in the decision on whether to initiate oral anticoagulation.
METHODS
This retrospective analysis of FinCV Study from years 2003-2010 included 2074 patients who were not using any oral anticoagulation (long term or temporary) after CVs and undergoing a total of 6534 CVs for AF from emergency departments of three hospitals. Two study groups were formed: high CV frequency (mean interval between CVs ≤12 months and low frequency (>12 months).
RESULTS
A total of 107 SSEs occurred during a mean follow-up of 5.4 years. The event rates per 100 patient-years were 1.82 and 0.67 in high versus low CV frequency groups, respectively. After adjustment for CHADS-VASc score, CV frequency independently predicted SSE (HR, 2.87 [95% CI, 1.47 to 5.64]; = .002) at 3 years. Competing risk analysis also identified CV frequency (sHR, 2.70 [95% CI, 1.38-5.31]; = .004) as an independent predictor for SSE. In patients with CHADS-VASc score 1 and low CV frequency, the SSE risk was only 0.08 per 100 patient-years.
CONCLUSIONS
Frequency of CVs for symptomatic AF episodes provides additional information on stroke risk in AF patients with CHADS-VASc score 1.Key messagesThis retrospective study offers a unique opportunity to observe the natural course of AF patients with infrequent episodes of clinical arrhythmia when they were not using OAC (before introduction of CHADS-VASc score).Stroke or systemic embolism rate was very low (0.08 per 100 patient-years) in patients with one CHADS-VASc point who visited the emergency room for cardioversion less than once a year.Frequency of cardioversions can be used for additional risk stratification in patients at intermediate risk of stroke based on CHADS-VASc score.
背景
心房颤动（AF）患者根据个体患者特征选择口服抗凝治疗。关于临床 AF 负担与缺血性卒中和全身性栓塞（SSE）风险之间的关联，信息很少。本研究旨在探讨以心律失常转复（CV）的频率作为临床 AF 负担的衡量标准，与基于 CHADS-VASc 评分的中等卒中风险患者的长期 SSE 风险之间的关联。对于这些患者，通过评估 CV 频率进行额外的 SSE 风险分层可能有助于决定是否开始口服抗凝治疗。
方法
本研究为 2003-2010 年 FinCV 研究的回顾性分析，纳入了 2074 名在 CV 后未使用任何口服抗凝药（长期或临时）且在三家医院急诊科共进行 6534 次 AF 心律失常转复的患者。形成两个研究组：高 CV 频率组（平均 CV 间隔≤12 个月）和低频率组（>12 个月）。
结果
平均随访 5.4 年后共发生 107 例 SSE。高 CV 频率组和低 CV 频率组的每 100 患者年事件发生率分别为 1.82 和 0.67。在调整 CHADS-VASc 评分后，CV 频率独立预测 SSE（HR，2.87[95%CI，1.47-5.64]；=0.002），3 年后风险仍然存在。竞争风险分析也确定 CV 频率（sHR，2.70[95%CI，1.38-5.31]；=0.004）是 SSE 的独立预测因素。在 CHADS-VASc 评分为 1 分且 CV 频率较低的患者中，SSE 风险仅为每 100 患者年 0.08。
结论
对于有症状的 AF 发作的心律失常转复频率为 CHADS-VASc 评分 1 分的 AF 患者提供了有关卒中风险的额外信息。
关键信息
本回顾性研究提供了一个独特的机会，可以观察到当 CHADS-VASc 评分尚未引入时，临床心律失常发作不频繁的 AF 患者的自然病程。在每年到急诊室进行心律失常转复次数少于一次的 CHADS-VASc 评分 1 分的患者中，卒中或全身性栓塞的发生率非常低（每 100 患者年 0.08）。心律失常转复的频率可以用于基于 CHADS-VASc 评分的中等卒中风险患者的进一步风险分层。
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