■在有缺血性卒中(IS)病史的患者中,延长心脏监测(PCM)大大改善了亚临床房颤(AF)的检测,导致抗凝剂的迅速启动。然而,PCM是否可能导致IS预防仍然模棱两可。
■在本系统综述和荟萃分析中,随机对照临床试验(RCT)报告已知心血管危险因素患者的IS率,包括但不限于IS的历史,将接受PCM超过7天的患者与更保守的心律监测方法进行汇总.
■共纳入7项随机对照试验,包括9048名至少有一个已知心血管危险因素且接受心律监测的患者。与常规监测相比,PCM与IS发生率降低相关(风险比:0.76;95%CI:0.59-0.96;I2=0%)。在研究植入式心脏监测的RCT亚组中,这种关联也很重要(风险比:0.75;95%CI:0.58-0.97;I2=0%)。然而,当排除在一级和二级预防环境中评估PCM的RCT时,或当包括研究持续时间为7天或更短的PCM的RCT时,PCM和IS减少之间的关联没有保留其统计学意义.关于次要结果,PCM与房颤检测和抗凝启动的可能性更高相关。PCM和IS/短暂性脑缺血发作之间没有关联,全因死亡率,颅内出血,或者大出血.
■PCM可能代表特定患者的有效卒中预防策略。需要额外的随机对照试验来验证报告的关联的稳健性。
Prolonged cardiac monitoring (PCM) substantially improves the detection of subclinical atrial fibrillation (AF) among patients with history of ischemic stroke (IS), leading to prompt initiation of anticoagulants. However, whether PCM may lead to IS prevention remains equivocal.
In this systematic
review and meta-analysis, randomized-controlled clinical trials (RCTs) reporting IS rates among patients with known cardiovascular risk factors, including but not limited to history of IS, who received PCM for more than 7 days versus more conservative cardiac rhythm monitoring methods were pooled.
Seven RCTs were included comprising a total of 9048 patients with at least one known cardiovascular risk factor that underwent cardiac rhythm monitoring. PCM was associated with reduction of IS occurrence compared to conventional monitoring (Risk Ratio: 0.76; 95% CI: 0.59-0.96; I 2 = 0%). This association was also significant in the subgroup of RCTs investigating implantable cardiac monitoring (Risk Ratio: 0.75; 95% CI: 0.58-0.97; I 2 = 0%). However, when RCTs assessing PCM in both primary and secondary prevention settings were excluded or when RCTs investigating PCM with a duration of 7 days or less were included, the association between PCM and reduction of IS did not retain its statistical significance. Regarding the secondary outcomes, PCM was related to higher likelihood for AF detection and anticoagulant initiation. No association was documented between PCM and IS/transient ischemic attack occurrence, all-cause mortality, intracranial hemorrhage, or major bleeding.
PCM may represent an effective stroke prevention strategy in selected patients. Additional RCTs are warranted to validate the robustness of the reported associations.