Center for Adults with Congenital Heart Disease (ACHD), Sahlgrenska University Hospital/Östra, Sweden; Institute of Medicine, Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, Gothenburg University, Sweden.
Department of Business Administration, School of Business, Economics and Law, University of Gothenburg.
J Stroke Cerebrovasc Dis. 2023 Jun;32(6):107084. doi: 10.1016/j.jstrokecerebrovasdis.2023.107084. Epub 2023 Mar 23.
We aimed to investigate the risk of recurrent stroke in patients with transcatheter closure of an atrial shunt (ASCIos), compared to patients with an atrial shunt and cerebrovascular event (CVE) but only medical treated (ASMed), and to age- and sex-matched control individuals without a previous CVE.
In total, 663 ASCIos patients were identified in the Swedish National Patient Register from 1997 to 2016 and matched by using propensity score with 663 ASMed patients. Nine age- and sex-matched controls to ASCIos patients (n = 6,302) without a diagnosis of atrial shunt or history of CVE were randomly selected from the general population.
At a mean follow-up of 6.5 years, the incidence rate of recurrent stroke in the ASCIos group vs ASMed group was 0.9 vs 0.7 per 100 patient-years. The hazard ratio of recurrent stroke in the ASCIos group compared with index stroke in the control group was 9.9 (95% confidence interval, 5.5-17.9). The incidence of atrial fibrillation was similar in the ASCIos and the ASMed group, however four times higher in the ASCIos than in the control group.
Our large nationwide, register-based cohort study showed that, unexpectedly, the risk of recurrent stroke in the ASCos group was as high as in the ASMed group and almost ten times higher than the risk of an index stroke in matched controls without previous stroke.
我们旨在调查经导管卵圆孔未闭封堵术（ASCIos）患者与卵圆孔未闭合并脑血管事件（CVE）但仅接受药物治疗的患者（ASMed）相比，以及与无既往 CVE 的年龄和性别匹配的对照个体相比，复发性卒中的风险。
从 1997 年至 2016 年，我们在瑞典国家患者登记处共确定了 663 例 ASCIos 患者，并使用倾向评分与 663 例 ASMed 患者进行匹配。从普通人群中随机选择 9 例与 ASCIos 患者（n=6302 例）年龄和性别匹配且无卵圆孔未闭或既往 CVE 诊断的对照个体。
在平均 6.5 年的随访中，ASCIos 组与 ASMed 组的复发性卒中发生率分别为 0.9/100 患者年和 0.7/100 患者年。ASCIos 组与对照组指数性卒中相比，复发性卒中的风险比为 9.9（95%置信区间，5.5-17.9）。ASCIos 组和 ASMed 组的心房颤动发生率相似，但前者比后者高 4 倍。
我们的这项大型全国性基于登记的队列研究表明，出乎意料的是，ASCIos 组的复发性卒中风险与 ASMed 组相当，几乎是无既往卒中的匹配对照组指数性卒中风险的 10 倍。
