Risk of Ischemic Stroke after Intracranial Hemorrhage in Patients with Atrial Fibrillation.
Risk of Ischemic Stroke after Intracranial Hemorrhage in Patients with Atrial Fibrillation.
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DOI：
10.1371/journal.pone.0145579
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Kamel H
中科院分区：
文献类型：
--
作者：
Lerario MP;Gialdini G;Lapidus DM;Shaw MM;Navi BB;Merkler AE;Lip GY;Healey JS;Kamel H
我们的目的是评估房颤患者颅内出血后缺血性卒中的风险。使用2005年至2012年加州、佛罗里达和纽约所有非联邦急症护理医院和急诊科的出院数据，我们确定了首次记录的房颤诊断患者。缺血性卒中和颅内出血使用经验证的诊断代码进行识别。Kaplan-Meier生存统计和考克斯比例风险分析用于评估缺血性卒中的累积发生率以及颅内出血事件与随后卒中之间的关系。在2，084，735例房颤患者中，在平均3.2年的随访期内，50，468例（2.4%）发生颅内出血，89，594例（4.3%）发生缺血性卒中。脑出血后1年累积卒中率为8.1%（95% CI，7.5-8.7%），硬膜下出血后为3.9%（95% CI，3.5-4.3%），无颅内出血者为2.0%（95% CI，2.0-2.1%）。在校正了CHA 2DS 2-VASc评分后，脑内出血（风险比[HR]，2.8; 95% CI，2.6-2.9）和硬膜下出血（HR，1.6; 95% CI，1.5-1.7）后卒中风险均升高。累积1年卒中发生率范围为0.9%（硬膜下出血且CHA 2DS 2-VASc评分为0）至33.3%（脑内出血且CHA 2DS 2-VASc评分为9）。在一个大型异质性队列中，房颤患者颅内出血后缺血性卒中的风险显著升高。在脑出血和高CHA 2DS 2-VASc评分的患者中，风险最显著。
We aimed to estimate the risk of ischemic stroke after intracranial hemorrhage in patients with atrial fibrillation. Using discharge data from all nonfederal acute care hospitals and emergency departments in California, Florida, and New York from 2005 to 2012, we identified patients at the time of a first-recorded encounter with a diagnosis of atrial fibrillation. Ischemic stroke and intracranial hemorrhage were identified using validated diagnosis codes. Kaplan-Meier survival statistics and Cox proportional hazard analyses were used to evaluate cumulative rates of ischemic stroke and the relationship between incident intracranial hemorrhage and subsequent stroke. Among 2,084,735 patients with atrial fibrillation, 50,468 (2.4%) developed intracranial hemorrhage and 89,594 (4.3%) developed ischemic stroke during a mean follow-up period of 3.2 years. The 1-year cumulative rate of stroke was 8.1% (95% CI, 7.5–8.7%) after intracerebral hemorrhage, 3.9% (95% CI, 3.5–4.3%) after subdural hemorrhage, and 2.0% (95% CI, 2.0–2.1%) in those without intracranial hemorrhage. After adjustment for the CHA2DS2-VASc score, stroke risk was elevated after both intracerebral hemorrhage (hazard ratio [HR], 2.8; 95% CI, 2.6–2.9) and subdural hemorrhage (HR, 1.6; 95% CI, 1.5–1.7). Cumulative 1-year rates of stroke ranged from 0.9% in those with subdural hemorrhage and a CHA2DS2-VASc score of 0, to 33.3% in those with intracerebral hemorrhage and a CHA2DS2-VASc score of 9. In a large, heterogeneous cohort, patients with atrial fibrillation faced a substantially heightened risk of ischemic stroke after intracranial hemorrhage. The risk was most marked in those with intracerebral hemorrhage and high CHA2DS2-VASc scores.