リズム対レートコントロール療法と,その後の脳卒中または心房細動の患者における過渡性性不全性発作
Meytal Avgil Tsadok1, Cynthia A Jackevicius, Vidal Essebag
1MPH, McGill University Health Centre, 687 Pine Ave West, V Building, Montreal, Quebec, H3A 1A1 Canada.
Circulation
|November 6, 2012
まとめ
リズムコントロール療法では,ペースコントロールと比較して,心房細動患者における脳卒中および一時性心房不全発作 (TIA) のリスクが著しく低下しました. この利点は,高リスクの個人に最も顕著でした.
科学分野:
- 心臓病学 心臓病学
- 神経学 神経学とは
- 薬理学 薬理学とは
背景:
- 心房細動は脳卒中のリスクを高めます.
- 死亡率とリズム制御は受け入れられるが,脳卒中率の違いは不明である.
研究 の 目的:
- 動脈リズムとペースコントロール療法による脳卒中/TIAの比率を,心房細動患者で比較する.
主な方法:
- 人口ベースの観察研究 (ケベック州,1999-2007年) 関連行政データを用いた.
- リズムコントロール (クラスIa,Ic,III) とレートコントロール (ベータブロッカー,CCB,ディゴキシン) の患者における脳卒中/TIAの比率.
- 多変数コックス回帰と傾向スコアマッチングを使用した.
主要な成果:
- リズムコントロールの16,325人,レートコントロールの41,193人,平均フォローアップ期間は2.8年.
- 原発性脳卒中/TIA率:1.74/100人/年 (リズム) 対2.49/100人/年 (率),P<0.001.
- リズムコントロールは,脳卒中/TIAリスクの低さ (aHR 0.80,95%CI 0.74-0.87) と関連しており,特に中等/高 CHADS (CHADS2) リスクグループでは特にそうである.
結論:
- リズムコントロールセラピーは,心房細動患者におけるペースコントロールよりも,脳卒中/TIAの頻度が低いと関連しています.
- このメリットは,中等から高リスクの脳卒中の患者に特に顕著です.
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