Sidhu Gursukhman D S, Ayoub Tarek, El Hajjar Abdel Hadi, Dhorepatil Aneesh, Nedunchezian Saihariharan, Dagher Lilas, Ferdinand Keith, Marrouche Nassir
Tulane Research Innovation for Arrhythmia Discoveries, Tulane University School of Medicine, New Orleans, Louisiana, USA.
CJC Open. 2022 Feb 10;4(6):513-519. doi: 10.1016/j.cjco.2022.01.010. eCollection 2022 Jun.
Atrial fibrillation (AF) in acute ischemic stroke (AIS) is considered a binary entity regardless of AF type. We aim to investigate in-hospital morbidity and mortality among patients with nonparoxysmal AF-related AIS.
Patients hospitalized for AIS with associated paroxysmal or persistent AF were identified from the 2018 national inpatient sample database. We compared in-hospital mortality, stroke-related morbidity, hospital cost, length of stay, and discharge disposition in patients hospitalized with paroxysmal or persistent AF.
A total of 26,470 patients were hospitalized for AIS with paroxysmal or persistent AF. Patient with AIS with persistent AF had a longer hospital length of stay (paroxysmal AF, mean [M] 5.7 days, standard deviation [SD] ±6.8 days; persistent AF, M 7.4 days, SD ±11.9 days, < 0.001) and in-hospital costs (paroxysmal AF, M $15,449, SD ±$18,320; persistent AF, M $19,834 SD ±$23,312, < 0.001). Patients with AIS with permanent AF had higher in-hospital mortality (paroxysmal AF, 4.6%, vs permanent AF, 6.2%, < 0.001). Indirect markers of stroke-related disability, like intracranial hemorrhage (odds ratio [OR]: 1.9, 95% confidence interval (CI): 1.6-2.2), need for gastrostomy (OR: 2.1, 95% CI: 1.8-2.4), and tracheostomy (OR: 3.1, 95% CI: 2.1-4.4) were more associated with AIS from persistent AF.
Persistent AF is associated with poor in-hospital stroke-related outcome, possibly due to a worse thrombo-embolic phenomenon. AF pattern may be a harbinger of worse stroke-related morbidity.
急性缺血性卒中（AIS）中的房颤（AF）无论其类型如何均被视为一种二元实体。我们旨在调查非阵发性房颤相关急性缺血性卒中患者的院内发病率和死亡率。
从2018年全国住院患者样本数据库中识别出因急性缺血性卒中合并阵发性或持续性房颤而住院的患者。我们比较了阵发性或持续性房颤住院患者的院内死亡率、卒中相关发病率、住院费用、住院时间和出院处置情况。
共有26470例因急性缺血性卒中合并阵发性或持续性房颤而住院的患者。急性缺血性卒中合并持续性房颤的患者住院时间更长（阵发性房颤，平均[M]5.7天，标准差[SD]±6.8天；持续性房颤，M 7.4天，SD±11.9天，P<0.001）且住院费用更高（阵发性房颤，M 15449美元，SD±18320美元；持续性房颤，M 19834美元，SD±23312美元，P<0.001）。急性缺血性卒中合并永久性房颤的患者院内死亡率更高（阵发性房颤为4.6%，永久性房颤为6.2%，P<0.001）。卒中相关残疾的间接指标，如颅内出血（比值比[OR]：1.9，95%置信区间[CI]：1.6 - 2.2）、胃造口术需求（OR：2.1，95%CI：1.8 - 2.4）和气管切开术需求（OR：3.1，95%CI：2.1 - 4.4）与持续性房颤导致的急性缺血性卒中关联更大。
持续性房颤与院内卒中相关不良结局有关，可能是由于更严重的血栓栓塞现象。房颤类型可能是卒中相关发病率更差的一个预兆。
