Miller V T, Rothrock J F, Pearce L A, Feinberg W M, Hart R G, Anderson D C
Statistics and Epidemiology Research Corporation, Seattle, WA 98105.
Neurology. 1993 Jan;43(1):32-6. doi: 10.1212/wnl.43.1_part_1.32.
Ischemic strokes occurring in patients with nonrheumatic atrial fibrillation are due to a variety of mechanisms, not exclusively to cardiogenic embolism. Without knowledge of antithrombotic therapy assignment, we categorized strokes in the Stroke Prevention in Atrial Fibrillation Study as presumed cardioembolic or noncardioembolic. We then compared patient clinical and echocardiographic variables, as well as the efficacy of aspirin prophylaxis, for each stroke type. Of 71 ischemic strokes, we categorized 46 (65%) as cardioembolic, 13 (18%) as noncardioembolic, and 12 (17%) as of uncertain cause. Patients developing noncardioembolic strokes, relative to cardioembolic strokes, were more commonly men (p = 0.005) and were more likely to have left ventricular wall motion abnormalities by two-dimensional echocardiography (p = 0.002). Aspirin reduced the occurrence of strokes categorized as noncardioembolic significantly more than it did those categorized as cardioembolic (p = 0.01). These results emphasize the value of considering stroke mechanisms in therapeutic trials of antithrombotic agents and suggest a differential effect of aspirin according to mechanism.
非风湿性心房颤动患者发生的缺血性卒中是由多种机制引起的，并非仅仅是心源性栓塞。在不了解抗血栓治疗分配情况的前提下，我们将心房颤动卒中预防研究中的卒中分类为推测的心源性栓塞性或非心源性栓塞性。然后，我们比较了每种卒中类型的患者临床和超声心动图变量，以及阿司匹林预防的疗效。在71例缺血性卒中患者中，我们将46例（65%）分类为心源性栓塞性，13例（18%）为非心源性栓塞性，12例（17%）病因不明。与心源性栓塞性卒中患者相比，发生非心源性栓塞性卒中的患者男性更为常见（p = 0.005），并且通过二维超声心动图检查更有可能出现左心室壁运动异常（p = 0.002）。阿司匹林对分类为非心源性栓塞性卒中的预防作用比对分类为心源性栓塞性卒中的预防作用显著更强（p = 0.01）。这些结果强调了在抗血栓药物治疗试验中考虑卒中机制的价值，并提示阿司匹林根据机制具有不同的作用效果。
