{"title":"医院登记的 33,870 例心房颤动缺血性卒中患者的严重程度、预后及其周期性变化：日本卒中数据库。","authors":"Kazunori Toyoda, Sohei Yoshimura, Michikazu Nakai, Shinichi Wada, Kaori Miwa, Junpei Koge, Takashi Yoshida, Kenji Kamiyama, Tatsuya Mizoue, Taketo Hatano, Yasuhisa Yoshida, Yusuke Sasahara, Akiko Ishigami, Yoshitaka Iwanaga, Yoshihiro Miyamoto, Kazuo Minematsu, Shotai Kobayashi, Masatoshi Koga","doi":"10.5551/jat.65117","DOIUrl":null,"url":null,"abstract":"<p><strong>Aim: </strong>Severity, functional outcomes, and their secular changes in acute atrial fibrillation (AF)-associated stroke patients were determined.</p><p><strong>Methods: </strong>Acute ischemic stroke patients with AF in a hospital-based, multicenter, prospective registry from January-2000 through December-2020, were compared with those without AF. The co-primary outcomes were the initial severity assessed by the NIH Stroke Scale (NIHSS) score and favorable outcome assessed by the modified Rankin Scale scores 0-2 at hospital discharge.</p><p><strong>Results: </strong>Of the 142,351 patients studied, 33,870 had AF. AF patients had higher NIHSS scores (median 9 vs. 3, adjusted coefficient 5.468, 95% CI 5.354-5.582) than non-AF patients. Favorable outcome was less common in AF patients than in non-AF patients in the unadjusted analysis (48.4% vs. 70.4%), but it was more common with adjustment for the NIHSS score and other factors (adjusted OR 1.110, 95% CI 1.061-1.161). In AF patients, the NIHSS score decreased throughout the 21-year period (adjusted coefficient -0.088, 95% CI -0.115 - -0.061 per year), and the reduction was steeper than in non-AF patients (P＜0.001). In AF patients, favorable outcome became more common over the period (adjusted OR 1.018, 95% CI 1.010-1.026), and the increase was steeper than in non-AF patients (P＜0.001); the increase was no longer significant after further adjustment by reperfusion therapy.</p><p><strong>Conclusions: </strong>Initial stroke severity became milder and functional outcomes improved in AF patients over the 21-year period. These secular changes were steeper than in non-AF patients, suggesting that AF-associated stroke seemed to reap more benefit of recent development of stroke care than stroke without AF.</p>","PeriodicalId":15128,"journal":{"name":"Journal of atherosclerosis and thrombosis","volume":null,"pages":null},"PeriodicalIF":3.0000,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Severity, Outcomes, and their Secular Changes in 33,870 Ischemic Stroke Patients with Atrial Fibrillation in a Hospital-Based Registry: Japan Stroke Data Bank.\",\"authors\":\"Kazunori Toyoda, Sohei Yoshimura, Michikazu Nakai, Shinichi Wada, Kaori Miwa, Junpei Koge, Takashi Yoshida, Kenji Kamiyama, Tatsuya Mizoue, Taketo Hatano, Yasuhisa Yoshida, Yusuke Sasahara, Akiko Ishigami, Yoshitaka Iwanaga, Yoshihiro Miyamoto, Kazuo Minematsu, Shotai Kobayashi, Masatoshi Koga\",\"doi\":\"10.5551/jat.65117\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Aim: </strong>Severity, functional outcomes, and their secular changes in acute atrial fibrillation (AF)-associated stroke patients were determined.</p><p><strong>Methods: </strong>Acute ischemic stroke patients with AF in a hospital-based, multicenter, prospective registry from January-2000 through December-2020, were compared with those without AF. The co-primary outcomes were the initial severity assessed by the NIH Stroke Scale (NIHSS) score and favorable outcome assessed by the modified Rankin Scale scores 0-2 at hospital discharge.</p><p><strong>Results: </strong>Of the 142,351 patients studied, 33,870 had AF. AF patients had higher NIHSS scores (median 9 vs. 3, adjusted coefficient 5.468, 95% CI 5.354-5.582) than non-AF patients. Favorable outcome was less common in AF patients than in non-AF patients in the unadjusted analysis (48.4% vs. 70.4%), but it was more common with adjustment for the NIHSS score and other factors (adjusted OR 1.110, 95% CI 1.061-1.161). In AF patients, the NIHSS score decreased throughout the 21-year period (adjusted coefficient -0.088, 95% CI -0.115 - -0.061 per year), and the reduction was steeper than in non-AF patients (P＜0.001). In AF patients, favorable outcome became more common over the period (adjusted OR 1.018, 95% CI 1.010-1.026), and the increase was steeper than in non-AF patients (P＜0.001); the increase was no longer significant after further adjustment by reperfusion therapy.</p><p><strong>Conclusions: </strong>Initial stroke severity became milder and functional outcomes improved in AF patients over the 21-year period. These secular changes were steeper than in non-AF patients, suggesting that AF-associated stroke seemed to reap more benefit of recent development of stroke care than stroke without AF.</p>\",\"PeriodicalId\":15128,\"journal\":{\"name\":\"Journal of atherosclerosis and thrombosis\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.0000,\"publicationDate\":\"2024-08-29\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of atherosclerosis and thrombosis\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.5551/jat.65117\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"PERIPHERAL VASCULAR DISEASE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of atherosclerosis and thrombosis","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5551/jat.65117","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
引用次数: 0
摘要
目的：确定急性心房颤动（房颤）相关脑卒中患者的严重程度、功能预后及其长期变化：方法：将 2000 年 1 月至 2020 年 12 月在一家医院进行的多中心前瞻性登记中的急性缺血性脑卒中房颤患者与无房颤患者进行比较。共同主要结果是由美国国立卫生研究院卒中量表（NIHSS）评分评估的初始严重程度和出院时改良兰金量表 0-2 分评估的良好预后：在接受研究的 142,351 名患者中，33,870 人患有房颤。与非房颤患者相比，房颤患者的 NIHSS 评分更高（中位数为 9 vs. 3，调整系数为 5.468，95% CI 为 5.354-5.582）。在未经调整的分析中，心房颤动患者获得良好预后的比例低于非心房颤动患者（48.4% 对 70.4%），但在对 NIHSS 评分和其他因素进行调整后，心房颤动患者获得良好预后的比例更高（调整后 OR 为 1.110，95% CI 为 1.061-1.161）。心房颤动患者的 NIHSS 评分在 21 年间一直在下降（调整系数 -0.088，95% CI -0.115 -0.061/年），而且下降幅度比非心房颤动患者更大（P＜0.001）。在此期间，心房颤动患者的良好预后变得更为常见（调整后 OR 1.018，95% CI 1.010-1.026），且增幅比非心房颤动患者更大（P＜0.001）；根据再灌注治疗进一步调整后，增幅不再显著：结论：在 21 年的时间里，房颤患者最初的中风严重程度有所减轻，功能预后有所改善。结论：在 21 年的时间里，心房颤动患者的初始中风严重程度变得更轻，功能预后得到改善，与非心房颤动患者相比，心房颤动患者的这些长期变化更为陡峭，表明与心房颤动相关的中风似乎比无心房颤动的中风更受益于中风护理的最新发展。
Severity, Outcomes, and their Secular Changes in 33,870 Ischemic Stroke Patients with Atrial Fibrillation in a Hospital-Based Registry: Japan Stroke Data Bank.
Aim: Severity, functional outcomes, and their secular changes in acute atrial fibrillation (AF)-associated stroke patients were determined.
Methods: Acute ischemic stroke patients with AF in a hospital-based, multicenter, prospective registry from January-2000 through December-2020, were compared with those without AF. The co-primary outcomes were the initial severity assessed by the NIH Stroke Scale (NIHSS) score and favorable outcome assessed by the modified Rankin Scale scores 0-2 at hospital discharge.
Results: Of the 142,351 patients studied, 33,870 had AF. AF patients had higher NIHSS scores (median 9 vs. 3, adjusted coefficient 5.468, 95% CI 5.354-5.582) than non-AF patients. Favorable outcome was less common in AF patients than in non-AF patients in the unadjusted analysis (48.4% vs. 70.4%), but it was more common with adjustment for the NIHSS score and other factors (adjusted OR 1.110, 95% CI 1.061-1.161). In AF patients, the NIHSS score decreased throughout the 21-year period (adjusted coefficient -0.088, 95% CI -0.115 - -0.061 per year), and the reduction was steeper than in non-AF patients (P＜0.001). In AF patients, favorable outcome became more common over the period (adjusted OR 1.018, 95% CI 1.010-1.026), and the increase was steeper than in non-AF patients (P＜0.001); the increase was no longer significant after further adjustment by reperfusion therapy.
Conclusions: Initial stroke severity became milder and functional outcomes improved in AF patients over the 21-year period. These secular changes were steeper than in non-AF patients, suggesting that AF-associated stroke seemed to reap more benefit of recent development of stroke care than stroke without AF.
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