缺血性卒中前已知心房颤动患者与缺血性卒中后诊断出心房颤动患者的预后差异及危险因素分析。

Analysis of prognostic differences and risk factors in patients with atrial fibrillation known before ischemic stroke and atrial fibrillation diagnosed after ischemic stroke.

作者信息

Liu Dongjie, Zhao Yan, Zhang Bingwei, Lao Qi, Wang Lijia, Yi Xia, Chang Geng

机构信息

The First Affiliated Hospital of Dalian Medical University, No. 222, Zhongshan Road, Xigang, Dalian, 116011, Liaoning, People's Republic of China.

DaLian Rehabilitation Recuperation Center of Joint Logistics Support Force of PLA, No.30, Binhaixi Road, Xigang, Dalian, 116013, Liaoning, People's Republic of China.

出版信息

J Neurol. 2025 Apr 30;272(5):368. doi: 10.1007/s00415-025-13056-6.

DOI:10.1007/s00415-025-13056-6

PMID:40304787

Abstract

AIMS

To compare the 1-year prognoses of patients with atrial fibrillation known before stroke (KAF) with those diagnosed after (AFDAS) and to explore the reasons for any observed differences.

METHODS

420 ischemic stroke patients were assigned to the KAF and AFDAS group. Follow-up information for both groups included the incidence of ischemic stroke recurrence, poor neurofunctional outcomes, and all-cause mortality within one year after the original ischemic stroke episode. The differences in the two groups' prognoses were assessed, and Cox/logistic regression models were employed to identify the underlying factors influencing this prognostic gap.

RESULTS

AFDAS had significantly lower rates of ischemic stroke recurrence (11.06% vs. 19.34%, P = 0.018) and poor neurofunctional outcome (25.48% vs. 36.79%, P = 0.012) compared to KAF. One-year all-cause mortality was similar between the two groups (7.69% vs. 9.91%, P = 0.424). AFDAS had a significantly lower risk of ischemic stroke recurrence even after adjusting for mortality factors (HR, 0.542; 95% CI, 0.325-0.903; P = 0.019). The incidence rate of ischemic stroke recurrence was significantly lower in AFDAS compared to KAF after adjustment for non-cardiac factors (HR, 0.561; 95% CI, 0.316-0.995; P = 0.042). However, there was no discernible difference in the two groups after adjustment for cardiac factors (HR, 0.659/0.588; 95% CI, 0.390-1.115/0.327-1.058; P = 0.120/0.077). The probability of a poor neurofunctional outcome was 3.758-fold higher in patients with recurrent ischemic stroke compared to those without recurrence (HR, 3.758; 95% CI, 1.587-8.900; P = 0.003). Compared to KAF, AFDAS was 88% less likely to have a poor neurofunctional outcome (HR, 0.120; 95% CI, 0.052-0.277; P < 0.001).

CONCLUSION

Patients with AFDAS have a better prognosis than those with KAF.

摘要

目的

比较卒中前已知房颤（KAF）患者与卒中后诊断出房颤（AFDAS）患者的1年预后，并探究观察到的差异原因。

方法

420例缺血性卒中患者被分配至KAF组和AFDAS组。两组的随访信息包括缺血性卒中复发率、神经功能预后不良情况以及原始缺血性卒中发作后1年内的全因死亡率。评估两组预后的差异，并采用Cox/逻辑回归模型确定影响这一预后差距的潜在因素。

结果

与KAF相比，AFDAS的缺血性卒中复发率（11.06%对19.34%，P = 0.018）和神经功能预后不良率（25.48%对36.79%，P = 0.012）显著更低。两组的1年全因死亡率相似（7.69%对9.91%，P = 0.424）。即使在调整死亡率因素后，AFDAS的缺血性卒中复发风险仍显著更低（风险比[HR]，0.542；95%置信区间[CI]，0.325 - 0.903；P = 0.019）。在调整非心脏因素后，AFDAS的缺血性卒中复发率与KAF相比显著更低（HR，0.561；95% CI，0.316 - 0.995；P = 0.042）。然而，在调整心脏因素后，两组之间没有明显差异（HR，0.659/0.588；95% CI，0.390 - 1.115/0.327 - 1.058；P = 0.120/0.077）。与未复发的患者相比，缺血性卒中复发患者神经功能预后不良的概率高3.758倍（HR，3.758；95% CI，1.587 - 8.900；P = 0.003）。与KAF相比，AFDAS发生神经功能预后不良的可能性低88%（HR，0.120；95% CI，0.052 - 0.277；P < 0.001）。