Risk of ischaemic stroke according to pattern of atrial fibrillation: analysis of 6563 aspirin-treated patients in ACTIVE-A and AVERROES
Risk of ischaemic stroke according to pattern of atrial fibrillation: analysis of 6563 aspirin-treated patients in ACTIVE-A and AVERROES
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DOI：
10.1093/eurheartj/ehu307
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发表时间：
2015-02-01
影响因子：
39.3
通讯作者：
Connolly, Stuart J.
中科院分区：
文献类型：
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作者：
Vanassche, Thomas;Lauw, Mandy N.;Connolly, Stuart J.
房颤（AF）的发生模式-阵发性、持续性或永久性-与心房功能障碍和结构变化的进展阶段相关，因此可能与卒中风险的进展性升高相关。然而，以前的研究并没有一致显示AF模式预测中风，但已受到阻碍的低功率，可变事件的确定，可变抗凝剂use.Methods和结果的方法缺陷，我们分析了中风和全身栓塞率在6563阿司匹林治疗的AF患者的ACTIVE-A/AVERROES数据库。对事件和裁定进行了全面检索。进行多变量分析，调整已知的卒中危险因素。阵发性、持续性和永久性房颤患者的平均年龄分别为69.0 ± 9.9、68.6 ± 10.2和71.9 ± 9.8岁（P < 0.001）。阵发性和持续性房颤患者的CHA（2）DS（2）-VASc评分相似（3.1 ± 1.4），但永久性房颤患者的CHA（2）DS（2）-VASc评分较高（3.6 ± 1.5，P < 0.001）。阵发性、持续性和永久性房颤的年缺血性卒中发生率分别为2.1%、3.0%和4.2%，永久性与阵发性房颤的校正风险比为1.83（P < 0.001），持续性与阵发性房颤的校正风险比为1.44（P = 0.02）。多因素分析显示年龄>= 75岁、性别、卒中或TIA病史和AF类型是卒中的独立预测因素，其中AF类型是卒中或TIA的第二强预测因素。结论在大量非抗凝AF患者中，AF类型是卒中风险的独立预测因素，可能有助于评估抗凝治疗的风险/获益。特别是在低风险患者中。
Aims The pattern of atrial fibrillation (AF) occurrence-paroxysmal, persistent, or permanent-is associated with progressive stages of atrial dysfunction and structural changes and may therefore be associated with progressively higher stroke risk. However, previous studies have not consistently shown AF pattern to predict stroke but have been hampered by methodological shortcomings of low power, variable event ascertainment, and variable anticoagulant use.Methods and results We analysed the rates of stroke and systemic embolism in 6563 aspirin-treated patients with AF from the ACTIVE-A/AVERROES databases. There was thorough searching for events and adjudication. Multivariable analyses were performed with the adjustment for known risk factors for stroke. Mean age of patients with paroxysmal, persistent, and permanent AF was 69.0 +/- 9.9, 68.6 +/- 10.2, and 71.9 +/- 9.8 years (P < 0.001). The CHA(2)DS(2)-VASc score was similar in patients with paroxysmal and persistent AF (3.1 +/- 1.4), but was higher in patients with permanent AF (3.6 +/- 1.5, P < 0.001). Yearly ischaemic stroke rates were 2.1, 3.0, and 4.2% for paroxysmal, persistent, and permanent AF, respectively, with adjusted hazard ratio of 1.83 (P < 0.001) for permanent vs. paroxysmal and 1.44 (P = 0.02) for persistent vs. paroxysmal. Multivariable analysis identified age >= 75 year, sex, history of stroke or TIA, and AF pattern as independent predictors of stroke, with AF pattern being the second strongest predictor after prior stroke or TIA.Conclusion In a large population of non-anticoagulated AF patients, pattern of AF was a strong independent predictor of stroke risk and may be helpful to assess the risk/benefit for anticoagulant therapy, especially in lower risk patients.