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Neurology:卒中后,房颤诊断人群死亡风险更高

2021-04-09 Freeman MedSci原创

卒中后,房颤诊断人群死亡风险更高

心房颤动(AF)、卒中和口服抗凝疗法预防血栓栓塞之间的紧密联系已被广泛接受。在卒中后人群中长期进行心律监测,部分原因是因为卒中可以是房颤的最初临床表现。

具体来说,在缺血性卒中患者中,有25%的患者会出现心房颤动。 多项研究表明,与已知AF患者(KAF)相比,卒中后诊断为房颤(AFDAS)人群的血管合并症发病率较低,包括冠心病、既往心肌梗死(MI)和心力衰竭 。与那些在卒中后仍能维持窦性心律的患者相比,AFDAS患者复发卒中或死亡的风险更高或相似;但这些研究受限于对抗凝或抗血小板使用的极少了解,对心房颤动的评估往往局限于最初卒中的住院治疗,且只有1年的随访时间。

为了解决这个问题,美国宾夕法利亚大学的Anjali Bhatla等人,创建了一个事件、缺血性卒中事件的患者初始队列,并试图根据房颤诊断的时间来评估其全因死亡的风险。他们比较了卒中患者的死亡风险,包括(1)窦性心律、(2)已知AF(KAF)和(3)卒中后诊断AF(AFDAS)。

他们使用了创建了一个偶然卒中患者的初始队列。死亡事件在与国家死亡指数( National Death Index)数据关联后确定,直至2017年6月30日。并评估了整个研究期间,抗凝剂和抗血小板的启动情况。最后,利用Cox比例危险模型评估了卒中亚型和死亡之间的关联。

他们发现了1,489名发生缺血性卒中事件的个体,985人在研究期间的任何时候都没有发生房颤,215人在卒中前有KAF,160人在卒中后≤6个月发现房颤,129人在卒中后>6个月发现房颤。

经过4.9年的中位随访(四分位数范围1.9-6.8),共有686人死亡。卒中、无房颤组的年化死亡率为8.8%;KAF组为12.2%;AFDAS≤6个月组为15.8%;A

FDAS>6个月组为12.7%。AFDAS≤6个月组患者即使在对人口统计学、临床危险因素和使用抗血栓疗法进行多变量调整后,其全因死亡的独立风险也最高。

与卒中、无AF组相比,有KAF者的死亡风险更高,调整后变得不显著。

这个研究的重要意义在于发现了,AFDAS组的死亡风险最高,这一现象无法通过临床合并症或使用抗血栓疗法无法解释。

原文出处:

Stroke, Timing of Atrial Fibrillation Diagnosis, and Risk of Death
Anjali Bhatla, Yuliya Borovskiy, Ronit Katz, et al.
Neurology Mar 2021, 96 (12) e1655-e1662; DOI: 10.1212/WNL.0000000000011633

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    2021-10-25 yinhl1978
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    2021-04-09 我要当大牛

    AFDAS组的死亡风险最高,AFDAS病人可能为“隐形房颤病人”,轻度房颤没有明显症状,所以可能导致卒中为首发临床表现。

    0

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  5. [GetPortalCommentsPageByObjectIdResponse(id=2001294, encodeId=bce1200129431, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Mon Oct 25 16:55:40 CST 2021, time=2021-10-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1671423, encodeId=97b116e14232c, content=<a href='/topic/show?id=9f4e360191a' target=_blank style='color:#2F92EE;'>#卒中后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36019, encryptionId=9f4e360191a, topicName=卒中后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ff7426824786, createdName=waiwai3039, createdTime=Tue Oct 05 05:55:40 CST 2021, time=2021-10-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=955382, encodeId=6317955382ff, content=AFDAS组的死亡风险最高,AFDAS病人可能为“隐形房颤病人”,轻度房颤没有明显症状,所以可能导致卒中为首发临床表现。, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/202404/7c0f0744e05f40309717bd3bd8e7d180-AwOc8oY53AN8.jpg, createdBy=bd115474335, createdName=我要当大牛, createdTime=Fri Apr 09 08:16:32 CST 2021, time=2021-04-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1256069, encodeId=255d1256069ed, content=<a href='/topic/show?id=587f6339050' target=_blank style='color:#2F92EE;'>#死亡风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63390, encryptionId=587f6339050, topicName=死亡风险)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=quxin068, createdTime=Sat Apr 10 20:55:40 CST 2021, time=2021-04-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026813, encodeId=eab2102681378, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Fri Apr 09 08:55:40 CST 2021, time=2021-04-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1031368, encodeId=e0111031368a8, content=房颤,临床上碰到很多哦, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=心介, createdTime=Fri Apr 09 08:55:40 CST 2021, time=2021-04-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=955376, encodeId=4bec9553e652, content=脑心互关, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b7a31928393, createdName=学医无涯, createdTime=Fri Apr 09 07:21:43 CST 2021, time=2021-04-09, status=1, ipAttribution=)]
    2021-04-09 健健

    卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=2001294, encodeId=bce1200129431, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Mon Oct 25 16:55:40 CST 2021, time=2021-10-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1671423, encodeId=97b116e14232c, content=<a href='/topic/show?id=9f4e360191a' target=_blank style='color:#2F92EE;'>#卒中后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36019, encryptionId=9f4e360191a, topicName=卒中后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ff7426824786, createdName=waiwai3039, createdTime=Tue Oct 05 05:55:40 CST 2021, time=2021-10-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=955382, encodeId=6317955382ff, content=AFDAS组的死亡风险最高,AFDAS病人可能为“隐形房颤病人”,轻度房颤没有明显症状,所以可能导致卒中为首发临床表现。, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/202404/7c0f0744e05f40309717bd3bd8e7d180-AwOc8oY53AN8.jpg, createdBy=bd115474335, createdName=我要当大牛, createdTime=Fri Apr 09 08:16:32 CST 2021, time=2021-04-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1256069, encodeId=255d1256069ed, content=<a href='/topic/show?id=587f6339050' target=_blank style='color:#2F92EE;'>#死亡风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63390, encryptionId=587f6339050, topicName=死亡风险)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=quxin068, createdTime=Sat Apr 10 20:55:40 CST 2021, time=2021-04-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026813, encodeId=eab2102681378, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Fri Apr 09 08:55:40 CST 2021, time=2021-04-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1031368, encodeId=e0111031368a8, content=房颤,临床上碰到很多哦, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=心介, createdTime=Fri Apr 09 08:55:40 CST 2021, time=2021-04-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=955376, encodeId=4bec9553e652, content=脑心互关, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b7a31928393, createdName=学医无涯, createdTime=Fri Apr 09 07:21:43 CST 2021, time=2021-04-09, status=1, ipAttribution=)]
    2021-04-09 心介

    房颤,临床上碰到很多哦

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=2001294, encodeId=bce1200129431, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Mon Oct 25 16:55:40 CST 2021, time=2021-10-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1671423, encodeId=97b116e14232c, content=<a href='/topic/show?id=9f4e360191a' target=_blank style='color:#2F92EE;'>#卒中后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36019, encryptionId=9f4e360191a, topicName=卒中后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ff7426824786, createdName=waiwai3039, createdTime=Tue Oct 05 05:55:40 CST 2021, time=2021-10-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=955382, encodeId=6317955382ff, content=AFDAS组的死亡风险最高,AFDAS病人可能为“隐形房颤病人”,轻度房颤没有明显症状,所以可能导致卒中为首发临床表现。, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/202404/7c0f0744e05f40309717bd3bd8e7d180-AwOc8oY53AN8.jpg, createdBy=bd115474335, createdName=我要当大牛, createdTime=Fri Apr 09 08:16:32 CST 2021, time=2021-04-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1256069, encodeId=255d1256069ed, content=<a href='/topic/show?id=587f6339050' target=_blank style='color:#2F92EE;'>#死亡风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63390, encryptionId=587f6339050, topicName=死亡风险)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=quxin068, createdTime=Sat Apr 10 20:55:40 CST 2021, time=2021-04-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026813, encodeId=eab2102681378, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Fri Apr 09 08:55:40 CST 2021, time=2021-04-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1031368, encodeId=e0111031368a8, content=房颤,临床上碰到很多哦, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=心介, createdTime=Fri Apr 09 08:55:40 CST 2021, time=2021-04-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=955376, encodeId=4bec9553e652, content=脑心互关, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b7a31928393, createdName=学医无涯, createdTime=Fri Apr 09 07:21:43 CST 2021, time=2021-04-09, status=1, ipAttribution=)]
    2021-04-09 学医无涯

    脑心互关

    0

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