Kaarisalo M M, Immonen-Räihä P, Marttila R J, Salomaa V, Kaarsalo E, Salmi K, Sarti C, Sivenius J, Torppa J, Tuomilehto J
Department of Neurology, University of Turku, Finland.
Stroke. 1997 Feb;28(2):311-5. doi: 10.1161/01.str.28.2.311.
Atrial fibrillation (AF) is a risk factor for stroke. This study was undertaken to determine the influence of AF on the mortality of stroke patients and on the causes of death after a stroke event.
Patients with first ischemic stroke who were .35 to 74 years old and registered in the FINMONICA stroke register during 1982 through 1992 were analyzed (n = 6912). There were 642 patients with AF (9.3%) (mean age, 67 years) and 6270 patients without AF (90.3%) (mean age, 63 years). The association between AF and stroke mortality was investigated by use of logistic regression and Cox proportional hazards models.
Mortality was higher in the AF group both at 28 days (19.5% versus 14.4%, P < .001) and 1 year after the attack (30.5% versus 21.8%, P < .001). After adjustment for age and sex, the odds ratio for 28-day case fatality (AF versus non-AF) was 1.27 (95% CI, 1.03 to 1.56; P = .003), and that for 1-year mortality was 1.36 (95% CI, 1.14 to 1.63; P < .001). In the proportional hazards model, AF was a significant independent risk factor for 1-year mortality (hazard ratio, 1.26; 95% CI, 1.09 to 1.46; P = .002). Cardiac causes of death were more common in the AF group at the acute stage. In the course of 1 year, there were no differences in the distributions of causes of death.
Stroke patients with AF are at high risk of death both at the acute phase of stroke and during the subsequent year after the first acute stroke event. Mortality from cardiac diseases prevailed in the AF group during the acute phase of stroke. Careful cardiac evaluation and treatment are essential in patients with AF and stroke.
心房颤动（AF）是卒中的一个危险因素。本研究旨在确定AF对卒中患者死亡率及卒中事件后死亡原因的影响。
分析1982年至1992年期间在芬兰MONICA卒中登记处登记的年龄在35至74岁的首次缺血性卒中患者（n = 6912）。有642例AF患者（9.3%）（平均年龄67岁）和6270例无AF患者（90.3%）（平均年龄63岁）。采用逻辑回归和Cox比例风险模型研究AF与卒中死亡率之间的关联。
AF组在28天时的死亡率（19.5%对14.4%，P <.001）和发病后1年时的死亡率（30.5%对21.8%，P <.001）均较高。在调整年龄和性别后，28天病死率（AF组对非AF组）的比值比为1.27（95%CI，1.03至1.56；P =.003），1年死亡率的比值比为1.36（95%CI，1.14至1.63；P <.001）。在比例风险模型中，AF是1年死亡率的显著独立危险因素（风险比，1.26；95%CI，1.09至1.46；P =.002）。急性期AF组心脏性死亡原因更为常见。在1年的病程中，死亡原因分布无差异。
伴有AF的卒中患者在卒中急性期及首次急性卒中事件后的随后一年均处于高死亡风险。在卒中急性期，AF组中心脏疾病导致的死亡占主导。对伴有AF和卒中的患者进行仔细的心脏评估和治疗至关重要。
