Catheter ablation versus medical therapy for atrial fibrillation with prior stroke history:a prospective propensity score-mat-ched cohort study
Wen-Li DAI1
Zi-Xu ZHAO1
Chao JIANG1
Liu HE1
Ke-Xin YAO1
Yu-Feng WANG1
Ming-Yang GAO1
Yi-Wei LAI1
Jing-Rui ZHANG1
Ming-Xiao LI1
Song ZUO1
Xue-Yuan GUO1
Ri-Bo TANG1
Song-Nan LI1
Chen-Xi JIANG1
Nian LIU1
De-Yong LONG1
Xin DU2
Cai-Hua SANG1
Jian-Zeng DONG3
Chang-Sheng MA1
1.Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,National Clinical Research Center for Cardiovascular Diseases,Beijing,China2.Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,National Clinical Research Center for Cardiovascular Diseases,Beijing,China;Heart Health Research Center,Beijing,China3.Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,National Clinical Research Center for Cardiovascular Diseases,Beijing,China;Department of Cardio-vascular Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,China
摘要：BACKGROUND Patients with atrial fibrillation(AF)and prior stroke history have a high risk of cardiovascular events despite anticoagulation therapy.It is unclear whether catheter ablation(CA)has further benefits in these patients.
METHODS AF patients with a previous history of stroke or systemic embolism(SE)from the prospective Chinese Atrial Fibri-llation Registry study between August 2011 and December 2020 were included in the analysis.Patients were matched in a 1:1 ra-tio to CA or medical treatment(MT)based on propensity score.The primary outcome was a composite of all-cause death or isc-hemic stroke(IS)/SE.
RESULTS During a total of 4.1±2.3 years of follow-up,the primary outcome occurred in 111 patients in the CA group(3.3 per 100 person-years)and in 229 patients in the MT group(5.7 per 100 person-years).The CA group had a lower risk of the primary outcome compared to the MT group[hazard ratio(HR)=0.59,95％CI:0.47-0.74,P＜0.001].There was a significant decreasing risk of all-cause mortality(HR=0.43,95％CI:0.31-0.61,P＜0.001),IS/SE(HR=0.73,95％CI:0.54-0.97,P=0.033),cardiovascular mortality(HR=0.32,95％CI:0.19-0.54,P＜0.001)and AF recurrence(HR=0.33,95％CI:0.30-0.37,P＜0.001)in the CA group compared to that in the MT group.Sensitivity analysis generated consistent results when adjusting for time-dependent usage of anticoagulants.
CONCLUSIONS In AF patients with a prior stroke history,CA was associated with a lower combined risk of all-cause death or IS/SE.Further clinical trials are warranted to confirm the benefits of CA in these patients.
机标关键词：strokestudywithablationatrialcathetercohortfibrillation
论文发表日期：2023-10-28
在线出版日期：2025-08-15（本平台首次上网日期，不代表文献的发表时间）
页数：9( 707-715 )