基于筛查方法和检测时机，不同类型心房颤动的中风复发风险存在时差。

IF 5.8 3区医学 Q1 CLINICAL NEUROLOGY

European Stroke Journal Pub Date : 2024-11-26 DOI:10.1177/23969873241300888

Alonso Alvarado-Bolanos, Diana Ayan, Facundo Lodol, Alexander V Khaw, Lauren M Mai, Jennifer L Mandzia, Marko Mrkobrada, Maria Bres-Bullrich, Lorraine Fleming, Corbin Lippert, Meredith Cecile, Rodrigo Bagur, Sebastian Fridman, Luciano A Sposato

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引用次数: 0

摘要

导言：心房颤动（房颤）的负担会随着时间的推移而加重。在缺血性卒中（IS）患者中，根据时间和筛查方法的不同，房颤可在不同的负荷进展阶段被检测到。我们假设，在 IS 后通过 12 导联心电图（ECG-AF）和 14 天霍尔特长时间心脏监测（AFDAS）发现的房颤与中风发生前已知的房颤（KAF）相比，由于处于比 KAF 更早的进展阶段，IS 复发风险更低。此外，我们推测房颤类型之间的 IS 复发风险差异会随着时间的推移而变化，这是因为它们的进展阶段不同：回顾性观察队列研究，包括 KAF、ECG-AF 和 AFDAS [2018-2021]的 IS/TIA 患者。使用多变量病因特异性 Cox 比例危险模型估算调整后危险比（aHR），以比较 ECG-AF 与 KAF 和 AFDAS 与 KAF 之间的 IS 复发情况。对比例危险假设进行了检验，以评估IS复发风险差异是否随时间变化：在758例房颤患者（385例KAF、236例ECG-AF、137例AFDAS）中，603例接受了抗凝治疗，59例在随访1441年后出现IS复发。随访结束时，ECG-AF 和 KAF 之间未发现 IS 复发风险差异（aHR 0.67，95% CI 0.36-1.26），但 ECG-AF 仅在第一年内显示出较低的风险（aHR 0.15；95% CI 0.04-0.56）。AFDAS的IS复发风险低于KAF（aHR 0.22，95% CI 0.08-0.63），但无时变差异：讨论：ECG-AF和KAF的IS复发风险差异随时间而变化。然而，在整个研究期间，AFDAS 的 IS 风险始终低于 KAF。

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Time-varying differences in stroke recurrence risk between types of atrial fibrillation based on screening methods and timing of detection.

Introduction: Atrial fibrillation (AF) burden progresses with time. Among ischemic stroke (IS) patients, AF can be detected at different burden progression stages based on the timing and screening method. We hypothesized that AF detected after IS on 12-lead ECGs (ECG-AF) and via 14-day-Holter prolonged cardiac monitoring (AFDAS) are linked to lower IS recurrence risk than AF known before stroke occurrence (KAF) because of being at an earlier progression stage than KAF. Additionally, we posited that IS recurrence risk differences between AF types vary over time due to their differential progression stages.

Patients and methods: Retrospective observational cohort study including IS/TIA patients with KAF, ECG-AF, and AFDAS [2018-2021]. Adjusted hazard ratios (aHR) were estimated using multivariable cause-specific Cox proportional-hazard models to compare IS recurrence between ECG-AF versus KAF and AFDAS versus KAF. Proportional hazards assumptions were tested to assess whether IS recurrence risk differences were time-varying.

Results: Of 758 AF patients (385 KAF, 236 ECG-AF, 137 AFDAS), 603 received anticoagulation and 59 experienced a recurrent IS after 1441 patient-years of follow-up. No IS recurrence risk differences were observed at the end of follow-up between ECG-AF and KAF (aHR 0.67, 95% CI 0.36-1.26), although ECG-AF showed lower risk only within the first year (aHR 0.15; 95% CI 0.04-0.56). AFDAS exhibited a lower IS recurrence risk than KAF (aHR 0.22, 95% CI 0.08-0.63), without time-varying differences.

Discussion: Differences in IS recurrence risk between ECG-AF and KAF varied over time. However, AFDAS showed a consistently lower IS risk than KAF throughout the entire study period.

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来源期刊

European Stroke Journal Multiple-

CiteScore

7.50

自引率

6.60%

发文量

102

期刊介绍： Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.