Epidemiology of ischemic stroke from atrial fibrillation in Dijon, France, from 1985 to 2006
Epidemiology of ischemic stroke from atrial fibrillation in Dijon, France, from 1985 to 2006
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DOI：
10.1212/01.wnl.0000341280.31919.bd
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发表时间：
2009-01-27
期刊：
影响因子：
9.9
通讯作者：
Giroud, M.
中科院分区：
文献类型：
--
作者：
Bejot, Y.;Salem, D. Ben;Giroud, M.
背景资料：房颤（AF）与年龄密切相关，需要进行流行病学研究以评估人口老龄化和AF患者使用抗凝治疗对AF心源性栓塞性卒中发生率的影响（CE/AF卒中）。我们通过一项基于人群的前瞻性登记研究，评估了CE/AF卒中的发病率、危险因素、卒中前治疗和生存率的趋势，结果：共记录了3,064例缺血性卒中，包括572例（18.7%）CE/ AF卒中。在22年期间，观察到总体CE/ AF卒中的发生率降低（发生率比0.9858，95%置信区间[CI] 0.9731-0.9986; p = 0.03）。我们观察到CE/ AF卒中中既往AF、既往心肌梗死和年龄> 70岁患者的患病率更高（p < 0.0001），而高胆固醇血症在其他缺血性卒中中更常见（p = 0.003）。抗凝剂和抗血小板药物的使用显著增加，对于有AF病史的CE/ AF卒中尤其明显。对于CE/ AF卒中，1个月生存率为72（95% CI 0.68-0.76），1年时为52%（95% CI 0.48-0.56），2年时为43%（95%CI 0.39-0.48），仍低于其他缺血性脑卒中。我们研究中心源性栓塞/房颤中风发生率的下降可能是由于房颤患者抗血栓治疗的使用略有增加，但由于预期未来数年人口会老化，这类疗法的使用将不得不进一步增加。神经病学（R）2009; 72：346-353
Background: Atrial fibrillation (AF) is strongly associated with age, and epidemiologic studies are needed to evaluate the impact of both aging of the population and the use of anticoagulant therapy in patients with AF on the incidence of cardioembolic stroke with AF (CE/AF stroke).Methods: We evaluated trends in incidence rates, risk factors, prestroke therapy, and survival in CE/AF stroke from a prospective population-based registry, from 1985 to 2006.Results: A total of 3,064 ischemic strokes, including 572 (18.7%) CE/ AF strokes, were recorded. Over the 22 years, a decrease in the incidence of overall CE/ AF stroke was noted (incidence rate ratio 0.9858, 95% confidence interval [CI] 0.9731-0.9986; p = 0.03). We observed a higher prevalence of previous AF, previous myocardial infarction, and patients aged > 70 years in CE/ AF stroke (p < 0.0001) whereas hypercholesterolemia was more prevalent in other ischemic strokes (p = 0.003). A significant increase in the use of anticoagulants and antiplatelet agents was noted, and was particularly pronounced for CE/ AF stroke with previous AF. For CE/ AF stroke, survival rates were 72% at 1 month (95% CI 0.68-0.76), 52% at 1 year (95% CI 0.48-0.56), and 43% at 2 years (95% CI 0.39-0.48), and remained lower than those of other ischemic stroke.Conclusions: The decrease in the incidence of cardioembolic/atrial fibrillation stroke in our study was probably due to a slight increase in the utilization of antithrombotic therapy in patients with atrial fibrillation, but the use of such therapies will have to increase further because of the expected aging of the population in coming years. Neurology (R) 2009; 72: 346-353