Department of Internal Medicine, Staten Island University Hospital/Northwell Health, Staten Island, New York 10305, USA.
Department of Internal Medicine, Staten Island University Hospital/Northwell Health, Staten Island, New York 10305, USA.
J Stroke Cerebrovasc Dis. 2023 Sep;32(9):107247. doi: 10.1016/j.jstrokecerebrovasdis.2023.107247. Epub 2023 Jul 29.
Atrial fibrillation (Afib) is one of the most common and significant risk factors for stroke, with the CHADsVAsc score used as the tool for stroke risk assessment. Pulmonary hypertension (PH) has not been studied as an independent risk factor for stroke in individuals with Afib.
In this retrospective case-control study, National Inpatient Sample Database was used to sample individuals with atrial fibrillation, and baseline demographics and comorbidities were collected using ICD-10 codes. Patients with missing data, age under 18, history of thromboembolic diseases, or stroke were excluded. Greedy propensity matching using R was performed to match patients with and without PH on age, race, gender, and 19 other comorbidities, including anticoagulation use. Binary logistic regression was performed after matching to assess whether PH was an independent risk factor for stroke. A p-value of <0.05 was considered statistically significant.
Of the 2,421,545 patients included in the study, 158,545 (6.5%) had PH. PH patients were more likely to be elderly, females, and smokers. Comorbidities were more common in the PH group. Patients with PH were more likely to have an ischemic stroke (3.6% vs. 2.9%, p<0.001), hemorrhagic stroke (2.2% vs. 0.7%, p<0.001), and transient ischemic attack (TIA) (2.3% vs. 0.7%, p<0.001). After matching, the presence of PH was associated with increased ischemic stroke (OR: 1.2 [1.1-1.2]; p<0.001), hemorrhagic stroke (OR: 2.4 [2.1-2.6]; p<0.001) and TIA (OR: 2.2 [2.0-2.4]; p<0.001). PH patients also had increased length of stay (β = 0.8; p<0.001) mortality (OR: 1.1 [1.0-1.2]; p<0.001).
Apart from demonstrating the deleterious effect of PH on mortality and length of hospital stay, this study is the first to report on such a large scale that PH independently increases the incidence of all types of strokes in patients with Afib.
心房颤动（Afib）是中风的最常见和最重要的危险因素之一，使用 CHA2DS2-VASc 评分作为中风风险评估的工具。尚未研究肺动脉高压（PH）是否为 Afib 患者中风的独立危险因素。
在这项回顾性病例对照研究中，使用国家住院患者样本数据库对心房颤动患者进行抽样，并使用 ICD-10 代码收集基线人口统计学和合并症数据。排除数据缺失、年龄<18 岁、血栓栓塞疾病或中风史的患者。使用 R 进行贪婪倾向匹配，根据年龄、种族、性别和其他 19 种合并症（包括抗凝治疗）对有和没有 PH 的患者进行匹配。匹配后进行二元逻辑回归，以评估 PH 是否为中风的独立危险因素。p 值<0.05 被认为具有统计学意义。
在纳入的 2421545 例患者中，有 158545 例（6.5%）患有 PH。PH 患者更可能是老年人、女性和吸烟者。合并症在 PH 组中更为常见。PH 患者更可能发生缺血性中风（3.6%比 2.9%，p<0.001）、出血性中风（2.2%比 0.7%，p<0.001）和短暂性脑缺血发作（TIA）（2.3%比 0.7%，p<0.001）。匹配后，存在 PH 与缺血性中风（OR：1.2[1.1-1.2]；p<0.001）、出血性中风（OR：2.4[2.1-2.6]；p<0.001）和 TIA（OR：2.2[2.0-2.4]；p<0.001）的发生率增加相关。PH 患者的住院时间（β=0.8；p<0.001）和死亡率（OR：1.1[1.0-1.2]；p<0.001）也有所增加。
除了表明 PH 对死亡率和住院时间的不良影响外，本研究还首次报告了如此大规模的研究结果，表明 PH 独立增加了 Afib 患者所有类型中风的发生率。
