Severity, Outcomes, and their Secular Changes in 33,870 Ischemic Stroke Patients with Atrial Fibrillation in a Hospital-Based Registry: Japan Stroke Data Bank
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- Toyoda Kazunori
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
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- Yoshimura Sohei
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
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- Nakai Michikazu
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center Clinical Research Support Center, University of Miyazaki Hospital
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- Wada Shinichi
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
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- Miwa Kaori
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
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- Koge Junpei
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
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- Yoshida Takashi
- Department of Neurosurgery, Seijinkai Shimizu Hospital
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- Kamiyama Kenji
- Department of Neurosurgery, Nakamura Memorial Hospital
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- Mizoue Tatsuya
- Department of Neurosurgery, Suiseikai Kajikawa Hospital
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- Hatano Taketo
- Department of Neurosurgery, Kokura Memorial Hospital
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- Yoshida Yasuhisa
- Department of Neurosurgery, Cerebrovascular Research Institute, Eishokai Yoshida Hospital
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- Sasahara Yusuke
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
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- Ishigami Akiko
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
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- Iwanaga Yoshitaka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
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- Miyamoto Yoshihiro
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
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- Minematsu Kazuo
- Medical Corporation Iseikai
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- Kobayashi Shotai
- Shimane University School of Medicine, Izumo
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- Koga Masatoshi
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
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説明
<p> Aim: Severity, functional outcomes, and their secular changes in acute atrial fibrillation (AF)-associated stroke patients were determined.</p><p> Methods: Acute ischemic stroke patients with AF in a hospital-based, multicenter, prospective registry from January-2000 through December-2020, were compared with those without AF. The co-primary outcomes were the initial severity assessed by the NIH Stroke Scale (NIHSS) score and favorable outcome assessed by the modified Rankin Scale scores 0-2 at hospital discharge.</p><p> Results: Of the 142,351 patients studied, 33,870 had AF. AF patients had higher NIHSS scores (median 9 vs. 3, adjusted coefficient 5.468, 95% CI 5.354-5.582) than non-AF patients. Favorable outcome was less common in AF patients than in non-AF patients in the unadjusted analysis (48.4% vs. 70.4%), but it was more common with adjustment for the NIHSS score and other factors (adjusted OR 1.110, 95% CI 1.061-1.161). In AF patients, the NIHSS score decreased throughout the 21-year period (adjusted coefficient -0.088, 95% CI -0.115 – -0.061 per year), and the reduction was steeper than in non-AF patients (P＜0.001). In AF patients, favorable outcome became more common over the period (adjusted OR 1.018, 95% CI 1.010-1.026), and the increase was steeper than in non-AF patients (P＜0.001); the increase was no longer significant after further adjustment by reperfusion therapy.</p><p> Conclusions: Initial stroke severity became milder and functional outcomes improved in AF patients over the 21-year period. These secular changes were steeper than in non-AF patients, suggesting that AF-associated stroke seemed to reap more benefit of recent development of stroke care than stroke without AF.</p>
収録刊行物
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- Ｊｏｕｒｎａｌ ｏｆ Ａｔｈｅｒｏｓｃｌｅｒｏｓｉｓ ａｎｄ Ｔｈｒｏｍｂｏｓｉｓ
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Ｊｏｕｒｎａｌ ｏｆ Ａｔｈｅｒｏｓｃｌｅｒｏｓｉｓ ａｎｄ Ｔｈｒｏｍｂｏｓｉｓ 32 (3), 308-320, 2025-03-01
一般社団法人 日本動脈硬化学会
