英国心房颤动消融前后及倾向匹配对照的卒中发生率

IF 2.3 Q2 MEDICINE, GENERAL & INTERNAL
Pragmatic and Observational Research Pub Date : 2017-05-29 eCollection Date: 2017-01-01 DOI:10.2147/POR.S134781
Julian We Jarman, Tina D Hunter, Wajid Hussain, Jamie L March, Tom Wong, Vias Markides
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引用次数: 8

摘要

背景:我们试图确定心房颤动(AF)的导管消融是否与缺血性脑血管事件的发生率降低有关。方法和结果:使用常规收集的医院数据,通过直接和倾向评分匹配将消融患者与两个对照队列进行匹配。共有4991例消融患者与未消融的普通房颤对照组1:1匹配,5407例消融患者与接受心律转复的对照组相似匹配。在指标日期前后比较各组之间的年度缺血性卒中或短暂性缺血性发作(卒中/TIA)发生率。指标日期定义为普通房颤队列中第一次消融、第一次心律转复或第二次房颤事件。匹配人群具有非常相似的人口统计学和合并症特征,包括几乎相同的CHA2DS2-VASc风险分布(p值分别为0.6948和0.8152)。卒中/TIA风险统计模型显示,各队列之间的年事件发生率无差异(平均±标准误差0.30%±0.08%消融vs 0.28%±0.07%普通房颤,p=0.8292;消融0.37%±0.09% vs复律0.42%±0.08%,p=0.5198)。指数后模型显示,与各对照组相比,消融患者5年内卒中/TIA的年发生率显著降低(消融患者0.64%±0.11% vs普通房颤1.84%±0.23%,pp=0.0222)。结论:匹配导致具有相同基线缺血性脑血管事件风险和发生率的队列。在指标日期之后,消融组的年事件发生率显著降低。这些结果表明,转归率的差异源于指数日期开始的治疗途径的差异。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Stroke rates before and after ablation of atrial fibrillation and in propensity-matched controls in the UK.

Stroke rates before and after ablation of atrial fibrillation and in propensity-matched controls in the UK.

Background: We sought to determine whether catheter ablation of atrial fibrillation (AF) is associated with reduced occurrence of ischemic cerebrovascular events.

Methods and results: Using routinely collected hospital data, ablation patients were matched to two control cohorts via direct and propensity score matching. A total of 4,991 ablation patients were matched 1:1 to general AF controls with no ablation, and 5,407 ablation patients were similarly matched to controls who underwent cardioversion. Yearly rates of ischemic stroke or transient ischemic attack (stroke/TIA) before and after an index date were compared between cohorts. Index date was defined as the first ablation, the first cardioversion, or the second AF event in the general AF cohort. Matched populations had very similar demographic and comorbidity profiles, including nearly identical CHA2DS2-VASc risk distribution (p-values 0.6948 and 0.8152 vs general AF and cardioversion cohorts). Statistical models of stroke/TIA risk in the preindex period showed no difference in annual event rates between cohorts (mean±standard error 0.30% ± 0.08% ablation vs 0.28% ± 0.07% general AF, p=0.8292; 0.37% ± 0.09% ablation vs 0.42% ± 0.08% cardioversion, p=0.5198). Postindex models showed significantly lower annual rates of stroke/TIA in ablation patients compared with each control group over 5 years (0.64% ± 0.11% ablation vs 1.84% ± 0.23% general AF, p<0.0001; 0.82% ± 0.15% ablation vs 1.37% ± 0.18% cardioversion, p=0.0222).

Conclusion: Matching resulted in cohorts having the same baseline risks and rates of ischemic cerebrovascular events. After the index date, there were significantly lower yearly event rates in the ablation cohort. These results suggest the divergence in outcome rates stems from variance in the treatment pathways beginning at the index date.

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来源期刊
Pragmatic and Observational Research
Pragmatic and Observational Research MEDICINE, GENERAL & INTERNAL-
自引率
0.00%
发文量
11
期刊介绍: Pragmatic and Observational Research is an international, peer-reviewed, open-access journal that publishes data from studies designed to closely reflect medical interventions in real-world clinical practice, providing insights beyond classical randomized controlled trials (RCTs). While RCTs maximize internal validity for cause-and-effect relationships, they often represent only specific patient groups. This journal aims to complement such studies by providing data that better mirrors real-world patients and the usage of medicines, thus informing guidelines and enhancing the applicability of research findings across diverse patient populations encountered in everyday clinical practice.
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