Comparative occurrence of ischemic stroke with the rhythm versus rate control strategy in a national prospective cohort of atrial fibrillation

The Korean Journal of Internal Medicine

HyungWook Park¹  Junbeom Park²  Jin-Kyu Park³  Eue-Keun Choi⁴  Myung-Jin Cha⁴  Jae Guk Kim⁵  Changsoo Kim⁶  Young Soo Lee⁷  Ki-Woon Kang⁸  Jaemin Shim⁹  Jin-Bae Kim^1,10  Jung-Myung Lee^1,10  Jae-Sun Uhm^1,11  Tae-Hoon Kim^1,11  Boyoung Joung^1,11  Jun Kim^1,12 

[1] Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea;Department of Cardiology, Ewha Womans University School of Medicine, Seoul, Korea;Department of Cardiology, Hanyang University Seoul Hospital, Seoul, Korea;Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea;Department of Neurology, Eulji University Hospital, Daejeon, Korea;Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea;Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea;Division of Cardiology, Department of Internal Medicine, Eulji University Hospital, Daejeon, Korea;Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea;Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Korea;Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea;Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea;

关键词: atrial fibrillation;    rhythm;    rate;    stroke;   

DOI  :  10.3904/kjim.2019.063

来源: DOAJ

【 摘 要 】

Background/Aims Comparative occurrence of ischemic stroke for rhythm versus rate control strategy in patients with non-valvular atrial fibrillation (NVAF) is still inconclusive. The purpose of this study was to investigate whether the rhythm control strategy is associated with a lower risk of ischemic stroke compared to the rate control strategy in NVAF patients. Methods The CODE-AF registry prospectively enrolled 6,280 consecutive patients who were treated for NVAF at 10 tertiary referral centers in South Korea. Of these, 2,513 NVAF patients (age, 67 ± 10 years; male, 61.8%) were clinically followed up for over 1-year and divided into rate and rhythm control groups. Results Those treated with the rhythm control strategy were younger and had less proportions of underlying disease compared to those treated with the rate control strategy. After the propensity matching analysis, those treated with the rhythm control strategy had similar baseline characteristics including the CHA2DS2-VASC score compared to those treated with the rate control strategy. The rate of oral anticoagulation, all bleeding, and hospitalization were also similarly between the two groups. The incidence rate of ischemic stroke in the rhythm control group was significantly lower than in the rate control group (0.7 vs. 6.9 per 1,000 person-years, p = 0.011). Conclusions The rhythm control strategy demonstrated a beneficial effect to lower the risk of ischemic stroke during a 1-year follow-up compared to the rate control strategy.

【 授权许可】

Unknown