{"title":"出血性中风与缺血性中风后检测到的心房颤动的患病率、风险因素和预后价值。","authors":"Jiahuan Guo, Zixiao Li, Hongqiu Gu, Kaixuan Yang, Yanfang Liu, Jingjing Lu, Dandan Wang, Jiaokun Jia, Jia Zhang, Yongjun Wang, Xingquan Zhao","doi":"10.1136/svn-2023-002974","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and objectives: </strong>Prior evidence suggests that atrial fibrillation detected after stroke (AFDAS) is distinct from known atrial fibrillation (KAF), with particular clinical characteristics and impacts on outcomes in ischaemic stroke. However, the results remained inconsistent in ischaemic stroke, and the role of AFDAS in haemorrhagic stroke remains unclear. Therefore, we aimed to estimate the prevalence, risk factors and prognostic value of AFDAS in haemorrhagic stroke in comparison with ischaemic stroke.</p><p><strong>Methods: </strong>This was a multicentre cohort study. Patients who had an ischaemic and haemorrhagic stroke hospitalised in the Chinese Stroke Center Alliance hospitals were enrolled and classified as AFDAS, KAF or sinus rhythm (SR) based on heart rhythm. Univariate and multivariate logistic regression analyses were used to assess the prevalence, characteristics, risk factors and outcomes of AFDAS, KAF and SR in different stroke subtypes.</p><p><strong>Results: </strong>A total of 913 163 patients, including 818 799 with ischaemic stroke, 83 450 with intracerebral haemorrhage (ICH) and 10 914 with subarachnoid haemorrhage (SAH), were enrolled. AFDAS was the most common in ischaemic stroke. There were differences in the risk factor profile between stroke subtypes; older age is a common independent risk factor shared by ischaemic stroke (OR 1.06, 95% CI 1.06 to 1.06), ICH (OR 1.08, 95% CI 1.07 to 1.09) and SAH (OR 1.07, 95% CI 1.05 to 1.10). Similar to KAF, AFDAS was associated with an increased risk of in-hospital mortality compared with SR in both ischaemic stroke (OR 2.23, 95% CI 1.94 to 2.56) and ICH (OR 2.84, 95% CI 1.84 to 4.38).</p><p><strong>Discussion: </strong>There are differences in the prevalence, characteristics and risk factors for AFDAS and KAF in different stroke subtypes. AFDAS was associated with an increased risk of mortality compared with SR in both ischaemic stroke and ICH. Rhythm monitoring and risk factor modification after both ischaemic and haemorrhagic stroke are essential in clinical practice. More emphasis and appropriate treatment should be given to AFDAS.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":null,"pages":null},"PeriodicalIF":2.6000,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Prevalence, risk factors and prognostic value of atrial fibrillation detected after stroke after haemorrhagic versus ischaemic stroke.\",\"authors\":\"Jiahuan Guo, Zixiao Li, Hongqiu Gu, Kaixuan Yang, Yanfang Liu, Jingjing Lu, Dandan Wang, Jiaokun Jia, Jia Zhang, Yongjun Wang, Xingquan Zhao\",\"doi\":\"10.1136/svn-2023-002974\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and objectives: </strong>Prior evidence suggests that atrial fibrillation detected after stroke (AFDAS) is distinct from known atrial fibrillation (KAF), with particular clinical characteristics and impacts on outcomes in ischaemic stroke. However, the results remained inconsistent in ischaemic stroke, and the role of AFDAS in haemorrhagic stroke remains unclear. Therefore, we aimed to estimate the prevalence, risk factors and prognostic value of AFDAS in haemorrhagic stroke in comparison with ischaemic stroke.</p><p><strong>Methods: </strong>This was a multicentre cohort study. Patients who had an ischaemic and haemorrhagic stroke hospitalised in the Chinese Stroke Center Alliance hospitals were enrolled and classified as AFDAS, KAF or sinus rhythm (SR) based on heart rhythm. Univariate and multivariate logistic regression analyses were used to assess the prevalence, characteristics, risk factors and outcomes of AFDAS, KAF and SR in different stroke subtypes.</p><p><strong>Results: </strong>A total of 913 163 patients, including 818 799 with ischaemic stroke, 83 450 with intracerebral haemorrhage (ICH) and 10 914 with subarachnoid haemorrhage (SAH), were enrolled. AFDAS was the most common in ischaemic stroke. There were differences in the risk factor profile between stroke subtypes; older age is a common independent risk factor shared by ischaemic stroke (OR 1.06, 95% CI 1.06 to 1.06), ICH (OR 1.08, 95% CI 1.07 to 1.09) and SAH (OR 1.07, 95% CI 1.05 to 1.10). Similar to KAF, AFDAS was associated with an increased risk of in-hospital mortality compared with SR in both ischaemic stroke (OR 2.23, 95% CI 1.94 to 2.56) and ICH (OR 2.84, 95% CI 1.84 to 4.38).</p><p><strong>Discussion: </strong>There are differences in the prevalence, characteristics and risk factors for AFDAS and KAF in different stroke subtypes. AFDAS was associated with an increased risk of mortality compared with SR in both ischaemic stroke and ICH. Rhythm monitoring and risk factor modification after both ischaemic and haemorrhagic stroke are essential in clinical practice. 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引用次数: 0
摘要
背景和目的：先前的证据表明，卒中后检测到的心房颤动（AFDAS）有别于已知的心房颤动（KAF），在缺血性卒中中具有特殊的临床特征和对预后的影响。然而，缺血性中风的结果仍不一致，AFDAS 在出血性中风中的作用仍不清楚。因此，与缺血性卒中相比，我们旨在估算 AFDAS 在出血性卒中中的患病率、风险因素和预后价值：这是一项多中心队列研究。方法：这是一项多中心队列研究，研究对象为在中国卒中中心联盟医院住院治疗的缺血性和出血性卒中患者，根据心律将其分为 AFDAS、KAF 或窦性心律（SR）。采用单变量和多变量逻辑回归分析评估不同卒中亚型中 AFDAS、KAF 和 SR 的患病率、特征、风险因素和预后：共纳入 913 163 例患者，包括缺血性卒中 818 799 例、脑内出血（ICH）83 450 例和蛛网膜下腔出血（SAH）10 914 例。缺血性中风中最常见的是 AFDAS。中风亚型之间的风险因素存在差异；年龄较大是缺血性中风（OR 1.06，95% CI 1.06 至 1.06）、ICH（OR 1.08，95% CI 1.07 至 1.09）和 SAH（OR 1.07，95% CI 1.05 至 1.10）共同的独立风险因素。与 KAF 相似，在缺血性卒中（OR 2.23，95% CI 1.94 至 2.56）和 ICH（OR 2.84，95% CI 1.84 至 4.38）中，AFDAS 与 SR 相比增加了院内死亡风险：讨论：AFDAS 和 KAF 在不同卒中亚型中的患病率、特征和风险因素存在差异。在缺血性卒中和 ICH 中，与 SR 相比，AFDAS 与死亡风险增加相关。缺血性和出血性卒中后的节律监测和风险因素调整在临床实践中至关重要。应更加重视 AFDAS 并给予适当治疗。
Prevalence, risk factors and prognostic value of atrial fibrillation detected after stroke after haemorrhagic versus ischaemic stroke.
Background and objectives: Prior evidence suggests that atrial fibrillation detected after stroke (AFDAS) is distinct from known atrial fibrillation (KAF), with particular clinical characteristics and impacts on outcomes in ischaemic stroke. However, the results remained inconsistent in ischaemic stroke, and the role of AFDAS in haemorrhagic stroke remains unclear. Therefore, we aimed to estimate the prevalence, risk factors and prognostic value of AFDAS in haemorrhagic stroke in comparison with ischaemic stroke.
Methods: This was a multicentre cohort study. Patients who had an ischaemic and haemorrhagic stroke hospitalised in the Chinese Stroke Center Alliance hospitals were enrolled and classified as AFDAS, KAF or sinus rhythm (SR) based on heart rhythm. Univariate and multivariate logistic regression analyses were used to assess the prevalence, characteristics, risk factors and outcomes of AFDAS, KAF and SR in different stroke subtypes.
Results: A total of 913 163 patients, including 818 799 with ischaemic stroke, 83 450 with intracerebral haemorrhage (ICH) and 10 914 with subarachnoid haemorrhage (SAH), were enrolled. AFDAS was the most common in ischaemic stroke. There were differences in the risk factor profile between stroke subtypes; older age is a common independent risk factor shared by ischaemic stroke (OR 1.06, 95% CI 1.06 to 1.06), ICH (OR 1.08, 95% CI 1.07 to 1.09) and SAH (OR 1.07, 95% CI 1.05 to 1.10). Similar to KAF, AFDAS was associated with an increased risk of in-hospital mortality compared with SR in both ischaemic stroke (OR 2.23, 95% CI 1.94 to 2.56) and ICH (OR 2.84, 95% CI 1.84 to 4.38).
Discussion: There are differences in the prevalence, characteristics and risk factors for AFDAS and KAF in different stroke subtypes. AFDAS was associated with an increased risk of mortality compared with SR in both ischaemic stroke and ICH. Rhythm monitoring and risk factor modification after both ischaemic and haemorrhagic stroke are essential in clinical practice. More emphasis and appropriate treatment should be given to AFDAS.
期刊介绍：
Journal of Investigative Medicine (JIM) is the official publication of the American Federation for Medical Research. The journal is peer-reviewed and publishes high-quality original articles and reviews in the areas of basic, clinical, and translational medical research.
JIM publishes on all topics and specialty areas that are critical to the conduct of the entire spectrum of biomedical research: from the translation of clinical observations at the bedside, to basic and animal research to clinical research and the implementation of innovative medical care.
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