Ahn Hyo-Jeong, Go Young-Hae, Lee So-Ryoung, Choi JungMin, Lee Kyung-Yeon, Kwon Soonil, Choi Eue-Keun, Oh Seil, Lip Gregory Y H
Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Europace. 2025 Jun 3;27(6). doi: 10.1093/europace/euaf107.
Based on the diagnostic sequence in relation to stroke, a recent classification of atrial fibrillation (AF) categorizes AF into known AF (KAF) and AF detected after stroke or transient ischaemic attack (AFDAS). However, relatively little is known about AF 'concurrently diagnosed with stroke'-perhaps the 'grey zone' of AF between KAF and AFDAS, which has been less characterized in terms of its resemblance to clinical characteristics and outcomes compared with AFDAS or KAF.
Patients with AF who were admitted for acute ischaemic stroke (IS) in 2010-20 were retrospectively reviewed. Clinical characteristics and net clinical outcome (NCO)-the composite of recurrent stroke, major bleeding, hospitalization or emergency department visits for cardiovascular events, and death-were compared between AF diagnosed before stroke (prior AF) and incident AF diagnosed concurrently with IS (AFDCS). A total of 720 patients with AF and acute IS (mean age, 72.5 ± 10.1 years; 60.3% male) were included: prior AF, 62.6% (n = 451), and AFDCS, 37.4% (n = 269). Prior AF presented with more prevalent diabetes, heart failure, vascular disease, and valvular heart disease than AFDCS (all P < 0.05). The AFDCS had a significantly higher left ventricular ejection fraction and smaller left atrial diameter than prior AF. During a median follow-up of 2.0 (interquartile range 0.6-4.6) years, AFDCS was associated with a lower risk of NCO than prior AF without significant differences in the risk of recurrent stroke: adjusted hazard ratio (95% confidence interval), 0.776 (0.611-0.986), P = 0.038 for NCO and 0.784 (0.450-1.365), P = 0.389 for recurrent stroke.
Prior AF and AFDCS have distinctive clinical profiles supporting AF is a disease of continuum according to its diagnostic vicinity to the IS. In terms of recurrent IS, AFDCS has a comparable risk with prior AF, indicating the importance of early detection and integrated management of AF for patients with IS.
基于与卒中相关的诊断顺序，心房颤动（AF）的一种最新分类将AF分为已知AF（KAF）以及在卒中或短暂性脑缺血发作后检测到的AF（AFDAS）。然而，对于“与卒中同时诊断的AF”了解相对较少，这可能是KAF和AFDAS之间AF的“灰色地带”，与AFDAS或KAF相比，其在临床特征和预后方面的相似性方面的特征较少。
对2010 - 2020年因急性缺血性卒中（IS）入院的AF患者进行回顾性研究。比较卒中前诊断的AF（既往AF）和与IS同时诊断的新发AF（AFDCS）的临床特征和净临床结局（NCO），NCO是复发性卒中、大出血、因心血管事件住院或急诊就诊以及死亡的综合指标。共纳入720例AF合并急性IS患者（平均年龄72.5±10.1岁；男性占60.3%）：既往AF占62.6%（n = 451），AFDCS占37.4%（n = 269）。既往AF患者的糖尿病、心力衰竭、血管疾病和心脏瓣膜病比AFDCS更常见（均P < 0.05）。AFDCS的左心室射血分数显著高于既往AF，左心房直径小于既往AF。在中位随访2.0（四分位间距0.6 - 4.6）年期间，AFDCS的NCO风险低于既往AF，复发性卒中风险无显著差异：调整后的风险比（95%置信区间），NCO为0.776（0.611 - 0.986），P = 0.038；复发性卒中为0.784（0.450 - 1.365），P = 0.389。
既往AF和AFDCS具有独特的临床特征，支持AF根据其与IS的诊断接近程度是一种连续疾病。就复发性IS而言，AFDCS与既往AF的风险相当，表明对IS患者早期检测和综合管理AF的重要性。
