Béjot Yannick, Duloquin Gauthier, Guenancia Charles
Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cardiocerebrovascular diseases (PEC2), University of Burgundy, Dijon, France.
Department of Neurology, University Hospital of Dijon, Dijon, France.
Eur Stroke J. 2025 Mar;10(1):153-160. doi: 10.1177/23969873241266471. Epub 2024 Aug 7.
Current guidelines indicate prolonged cardiac rhythm monitoring for atrial fibrillation screening in patients with cryptogenic ischemic stroke (IS) or transient ischemic attack (TIA). This study aimed to assess the incidence of cryptogenic IS/TIA eligible for such investigation, and to estimate the number of patients potentially concerned in whole France annually.
All cryptogenic acute IS/TIA cases ⩾35 years old were retrieved from the population-based Dijon Stroke Registry, France (2013-2020). Patients eligible for prolonged cardiac rhythm monitoring were defined after excluding those who died in-hospital or within the first 30 days, or with preexisting major impairment. Annual incidence rates of eligible cryptogenic IS/TIA were calculated by age groups and sex. The total number of eligible patients in France was estimated by standardization to age- and sex-specific incidence.
Among 2811 IS/TIA patients recorded in the Dijon Stroke Registry, 1239 had cryptogenic IS/TIA of whom 1045 were eligible for prolonged cardiac rhythm monitoring (517 IS and 528 TIA, mean age 73.6 ± 14.6 years old, 55.4% women). Crude incidence rates of eligible cryptogenic IS/TIA were 169/100,000 per year (95% CI: 159-179) in overall sexes, 83/100,000 per year (95% CI: 76-91) for IS, and 85/100,000 per year (95% CI: 78-93) for TIA. The total number of patients with cryptogenic IS/TIA eligible for prolonged cardiac rhythm monitoring in France was estimated to be 66,125 (95% CI: 65,622-66,630) for the calendar year 2022, including 32,764 (95% CI: 32,410-33,120) with IS and 33,361 (95% CI: 33,004-33,721) with TIA.
This study demonstrated a high incidence of cryptogenic IS/TIA eligible for prolonged cardiac rhythm monitoring. Estimates at a national level pointed out the large number of patients who may require access to such atrial fibrillation screening, with attention to be paid on regarding organization of care networks and related costs.
当前指南指出，对于不明原因缺血性卒中（IS）或短暂性脑缺血发作（TIA）患者，应进行延长的心律监测以筛查房颤。本研究旨在评估适合此类检查的不明原因IS/TIA的发病率，并估计法国每年可能涉及的患者数量。
从法国第戎基于人群的卒中登记处（2013 - 2020年）检索所有年龄≥35岁的不明原因急性IS/TIA病例。排除在医院死亡或在最初30天内死亡或有既往严重功能障碍的患者后，确定符合延长心律监测条件的患者。按年龄组和性别计算符合条件的不明原因IS/TIA的年发病率。通过对年龄和性别特异性发病率进行标准化，估计法国符合条件的患者总数。
在第戎卒中登记处记录的2811例IS/TIA患者中，1239例患有不明原因IS/TIA，其中1045例符合延长心律监测条件（517例IS和528例TIA，平均年龄73.6±14.6岁，女性占55.4%）。符合条件的不明原因IS/TIA的粗发病率在总体人群中为每年169/100,000（95%CI：159 - 179），IS为每年83/100,000（95%CI：76 - 91），TIA为每年85/100,000（95%CI：78 - 93）。估计2022日历年法国符合延长心律监测条件的不明原因IS/TIA患者总数为66,125例（95%CI：65,622 - 66,630），其中IS患者32,764例（95%CI：32,410 - 33,120），TIA患者33,361例（95%CI：33,004 - 33,721）。
本研究表明，适合延长心律监测的不明原因IS/TIA发病率较高。国家层面的估计指出，大量患者可能需要进行此类房颤筛查，需要关注护理网络的组织和相关成本。
