한빛사논문
- 조회861
Do Yeon Kim 1, Seok-Gil Han 1, Han-Gil Jeong 1 2, Keon-Joo Lee 1 3, Beom Joon Kim 1, Moon-Ku Han 1, Kang-Ho Choi 4, Joon-Tae Kim 4, Dong-Ick Shin 5, Jae-Kwan Cha 6, Dae-Hyun Kim 6, Dong-Eog Kim 7, Wi-Sun Ryu 7 8, Jong-Moo Park 9, Kyusik Kang 10, Jae Guk Kim 11, Soo Joo Lee 11, Mi-Sun Oh 12, Kyung-Ho Yu 12, Byung-Chul Lee 12, Hong-Kyun Park 13, Keun-Sik Hong 13, Yong-Jin Cho 13, Jay Chol Choi 14, Sung Il Sohn 15, Jeong-Ho Hong 15, Tai Hwan Park 16, Kyung Bok Lee 17, Jee-Hyun Kwon 18, Wook-Joo Kim 18, Jun Lee 1 19 20, Ji Sung Lee 21, Juneyoung Lee, Philip B Gorelick 22, Hee-Joon Bae 1
1Department of Neurology and Cerebrovascular Center, Seoul National University College of Medicine, Seongnam, Republic of Korea. (D.Y.K., S.-G.H., H.-G.J., K.-J.L., B.J.K., M.-K.H., H.-J.B.).
2Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea. (H.-G.J.).
3Department of Neurology, Korea University Guro Hospital, Seoul, Republic of Korea (K.-J.L.).
4Department of Neurology, Chonnam National University Hospital, Gwangju, Republic of Korea (K.-H.C., J.-T.K.).
5Department of Neurology, Chungbuk National University Hospital, Cheongju, Republic of Korea (D.-I.S.).
6Department of Neurology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea (J.K.C., D.H.K.).
7Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Republic of Korea (D.-E.K., W.-S.R.).
8Artificial Intelligence R&D, JLK Corp, Seoul, Republic of Korea (W.-S.R.).
9Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Republic of Korea (J.-M.P.).
10Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea (K.K.).
11Department of Neurology, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Republic of Korea (J.G.K., S.J.L.).
12Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea (M.-S.O., K.-H.Y., B.-C.L.).
13Department of Neurology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea (H.-K.P., K.-S.H., Y.-J.C.,).
14Department of Neurology, Jeju National University Hospital, Jeju National University School of Medicine, Republic of Korea (J.C.C.).
15Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea (S.I.S., J.-H.H.).
16Department of Neurology, Seoul Medical Center, Republic of Korea (T.H.P.).
17Department of Neurology, Soonchunhyang University Hospital, Seoul, Republic of Korea (K.B.L.).
18Department of Neurology, Ulsan University Hospital, Ulsan University College of Medicine, Republic of Korea (J.-H.K., W.-J.K.).
19Department of Neurology, Yeungnam University Hospital, Daegu, Republic of Korea (J.L.).
20Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea (J.L.).
21Clinical Research Center, Asan Medical Center, Seoul, Republic of Korea (J.S.L.).
22Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (P.B.G.).
Correspondence to: Hee-Joon Bae, MD, PhD
Abstract
Background:
We aimed to evaluate covert brain infarction (CBI), frequently encountered during the diagnostic work-up of acute ischemic stroke, as a risk factor for stroke recurrence in patients with atrial fibrillation (AF).
Methods:
For this prospective cohort study, from patients with acute ischemic stroke hospitalized at 14 centers between 2017 and 2019, we enrolled AF patients without history of stroke or transient ischemic attack and divided them into the CBI (+) and CBI (−) groups. The 2 groups were compared regarding the 1-year cumulative incidence of recurrent ischemic stroke and all-cause mortality using the Fine and Gray subdistribution hazard model with nonstroke death as a competing risk and the Cox frailty model, respectively. Each CBI lesion was also categorized into either embolic-appearing (EA) or non-EA pattern CBI. Adjusted hazard ratios and 95% CIs of any CBI, EA pattern CBI only, non-EA pattern CBI only, and both CBIs were estimated.
Results:
Among 1383 first-ever stroke patients with AF, 578 patients (41.8%) had CBI. Of these 578 with CBI, EA pattern CBI only, non-EA pattern CBI only, and both CBIs were 61.8% (n=357), 21.8% (n=126), and 16.4% (n=95), respectively. The estimated 1-year cumulative incidence of recurrent ischemic stroke was 5.2% and 1.9% in the CBI (+) and CBI (−) groups, respectively (P=0.001 by Gray test). CBI increased the risk of recurrent ischemic stroke (adjusted hazard ratio [95% CI], 2.91 [1.44–5.88]) but did not the risk of all-cause mortality (1.32 [0.97–1.80]). The EA pattern CBI only and both CBIs elevated the risk of recurrent ischemic stroke (2.76 [1.32–5.77] and 5.39 [2.25–12.91], respectively), while the non-EA pattern only did not (1.44 [0.40–5.16]).
Conclusions:
Our study suggests that AF patients with CBI might have increased risk of recurrent stroke. CBI could be considered when estimating the stroke risk in patients with AF.
논문정보
- Research article
- 2022년 10월 (BRIC 등록일 2022-12-14)
- 국내(교신)+국외 연구진
- 의약학 > 신경의학
댓글 작성 로그인
팝업 닫기관련 링크
연구자 키워드
관련분야 연구자보기
소속기관 논문보기
관련분야 논문보기
해당논문 저자보기
