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Abstract：
The clinical characteristics and long-term outcomes of patients with ischemic stroke (IS) and atrial fibrillation detected after stroke (AFDAS) have not been clearly established. Previous studies evaluating patients with AFDAS were limited by the low prescription rates of anticoagulants and short follow-up periods. Consecutive patients hospitalized for IS between 2014 and 2017 were identified from a National Health Insurance Research Database. The included patients were categorized into three groups: (1) known diagnosis of AF (KAF) before the index stroke, (2) AFDAS, and (3) without AF (non-AF). Univariable and multivariable Cox regression analyses were performed to estimate the hazard ratio (HR) for independent variables and recurrent IS, hemorrhagic stroke, or all-cause mortality. We identified 158,909 patients with IS of whom 16,699 (10.5%) had KAF and 7,826 (4.9%) had AFDAS. The patients with AFDAS were younger, more often male, and had lower CHA2DS2-VASc scores (3.8 ± 1.9 versus 4.9 ± 1.8, p < 0.001) than the patients with KAF. Anticoagulant treatment significantly reduced the risks of all outcomes. The standardized mortality rates were 40.4, 28.6, and 18.4 (per 100 person-years) for the patients with KAF, AFDAS, and non-AF, respectively. Compared with AFDAS, KAF was associated with lower risks of recurrent IS [hazard ratio (HR): 0.91, 95% confidence interval (CI): 0.86-0.97, p < 0.01] and hemorrhagic stroke (HR: 0.88, 95% CI: 0.79-0.99, p < 0.01) and a higher risk of all-cause mortality (HR: 1.11, 95% CI: 1.07-1.16, p < 0.001). The risks of recurrent IS and hemorrhagic stroke were higher and of all-cause mortality was lower for patients with AFDAS than with KAF. There is a strong need to refine treatment modalities to reduce the high mortality in patients with KAF and AFDAS.
摘要：
缺血性卒中（IS）和卒中后房颤（AFDAS）患者的临床特征和长期预后尚未明确。先前评估AFDAS患者的研究受到抗凝剂处方率低和随访时间短的限制。从国家健康保险研究数据库中确定了2014年至2017年间因IS住院的连续患者。将纳入的患者分为三组：（1）在索引卒中之前已知的房颤（KAF）诊断，(2)美国联邦航空局,(3)无AF(非AF)。进行单变量和多变量Cox回归分析，以估计自变量和复发IS的风险比（HR）。出血性中风,或全因死亡率。我们确定了158,909例IS患者，其中16,699例（10.5％）患有KAF，7,826例（4.9％）患有AFDAS。AFDAS患者年龄较小,更多的是男性，与KAF患者相比，CHA2DS2-VASc评分较低（3.8±1.9对4.9±1.8，p<0.001）。抗凝治疗显著降低了所有结局的风险。KAF患者的标准化死亡率分别为40.4、28.6和18.4（每100人年），AFDAS,和非AF，分别。与AFDAS相比，KAF与复发性IS[风险比（HR）：0.91，95％置信区间（CI）：0.86-0.97，p<0.01]和出血性卒中（HR：0.88，95％CI：0.79-0.99，p<0.01）的风险较低，全因死亡风险较高（HR：1.11，95％CI：1.07-1.16，p<0.001）。AFDAS患者复发性IS和出血性卒中的风险较高，全因死亡率较低。迫切需要改进治疗方式以降低KAF和AFDAS患者的高死亡率。
