avkАрхивъ внутренней медициныThe Russian Archives of Internal Medicine2226-67042411-6564“SINAPS” LLC10.20514/2226-6704-2017-7-5-364-370avk-698Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLEВПЕРВЫЕ ДИАГНОСТИРОВАННАЯ ИНСУЛЬТ-АССОЦИИРОВАННАЯ ФИБРИЛЛЯЦИЯ ПРЕДСЕРДИЙ: РИСКИ РАЗВИТИЯ НЕБЛАГОПРИЯТНЫХ КЛИНИЧЕСКИХ ИСХОДОВ (РЕЗУЛЬТАТЫ СУБАНАЛИЗА КОГОРТНОГО ИССЛЕДОВАНИЯ АПОЛЛОН)NEWLY DIAGNOSED STROKE-ASSOCIATED ATRIAL FIBRILLATION: RISK OF DEVELOPMENT OF UNFAVORABLE CLINICAL OUTCOMES (THE RESULTS OF THE SUBANALYSIS COHORT STUDY APOLLO)ЗолотовскаяИ. А.ZolotovskayaI. A.

Самара, Россия

Samara, Russia

zolotovskay@list.ruДавыдкинИ. Л.DavydkinI. L.

Самара, Россия

Samara, Russia

ДупляковД. В.DuplyakovD. V.

Самара, Россия

Samara, Russia

ФГБОУ ВО «Самарский государственный медицинский университет» Минздрава России; ГБУЗ Самарской области «Самарская городская поликлиника № 9»РоссияSamara State Medical University of the Ministry of Health; Samara Oblast City Polyclinics № 9Russian FederationФГБОУ ВО «Самарский государственный медицинский университет» Минздрава РоссииРоссияSamara State Medical University of the Ministry of Health, Samara, RussiaRussian FederationФГБОУ ВО «Самарский государственный медицинский университет» Минздрава России; ГБУЗ «Самарский областной клинический кардиологический диспансер»РоссияSamara State Medical University of the Ministry of Health, Samara, Russia; Samara Oblast Clinical Dispensary of Cardiology, Samara, RussiaRussian Federation20172909201775364370Copyright © Золотовская И.А., Давыдкин И.Л., Дупляков Д.В., 20172017Золотовская И.А., Давыдкин И.Л., Дупляков Д.В.Zolotovskaya I.A., Davydkin I.L., Duplyakov D.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.medarhive.ru/jour/article/view/698Цель

Цель: изучить прогноз у пациентов с впервые диагностированной формой фибрилляции предсердий у пациентов, перенесших кардиоэмболический инсульт. Материал и методы. В открытое, проспективное исследование «АПОЛЛОН» (Антикоагулянтная терапия у Пациентов с фибриЛЛяцией предсердий, перенесших кардиоэмболический инсульт) за период 01.10.2013 — 31.03.2015 после этапа скрининга (n=1291) был включен 661 пациент с фибрилляцией предсердий, перенесший кардиоэмболический инсульт, средний возраст которых со- ставил 68,0 [62,0; 74,0] лет. Период наблюдения — 12 месяцев. Результаты. Отмечен высокий уровень коморбидности (артериальная ги- пертензия верифицирована у 100% пациентов, ишемическая болезнь сердца — у 61,4% больных, сахарный диабет у — 52,3%, и хроническая болезнь почек у 32,1% пациентов). У 154 (23,3%) пациентов ФП впервые была диагностирована в момент развития кардиоэмболического инсульта. Пациенты с впервые диагностированной формой фибрилляции предсердий были сопоставимы со всей группой по возрасту, по- казателю шкалы HAS-BLED, частоте встречаемости артериальной гипертензии, ИБС, но среди них достоверно чаще встречались пациенты с хронической болезнью почек, сахарным диабетом и инфарктом миокарда. Наибольшая смертность в течение года отмечена в группе пациентов с впервые диагностированной формой фибрилляции предсердий, где умерло — 46 (29,9%) человек, что статистически значимо больше, чем в целом как по всей группе больных с фибрилляции предсердий, перенесших кардиоэмболический инсульт, так и у пациентов с другим формами фибрилляции предсердий (р<0,001). Умершие больные с впервые диагностированной формой фибрилляции предсердий были достоверно старше, а также имели более выраженную степень неврологического дефицита по шкале NIHSS. Заключение. Полученные данные демонстрируют высокую распространенность и неблагоприятный прогноз впервые диагностированной формой фибрилляции предсердий у пациентов с кардиоэмболическим инсультом. Использование термина «впервые диагностированная инсульт-ассоциированная фибрилляция предсердий» логически обоснованно, что определяет как время наступления данной аритмии, так и высокий риск смертности у пациентов этой группы.

 

 

Objective

Objective: to study the prognosis of patients with first diagnosed atrial fibrillation in patients after cardioembolic stroke. Material and methods. In an open, prospective study “APOLLO” (Anticoagulation in Patients with atrial fibrillation, after cardioembolic stroke) for the period 01.10.2013 — 31.03.2015 after the stage of screening (n=1291) were included 661 patients with atrial fibrillation, after cardioembolic stroke, the average age was 68,0 [62,0; and 74,0] years. The observation period is 12 months. Results. Noted the high level of comorbidity (hypertension was verified in 100% of patients, ischemic heart disease — 61,4% of patients, diabetes in — 52,3%, and chronic kidney disease have to 32.1% of patients). At 154 (23,3%) patients AF was first diagnosed at the time of the development of cardioembolic stroke. Patients with first diagnosed atrial fibrillation were comparable with the whole group in age, indicator of the scale HAS-BLED, the frequency of occurrence of hypertension, but among them were significantly more frequently encountered patients with chronic kidney disease, diabetes, and myocardial infarction. The greatest mortality during the year was observed in the group of patients with first diagnosed atrial fibrillation, where he died — 46 (29.9 per cent) of people that is significantly more than the average across the group of patients with atrial fibrillation, after cardioembolic stroke, and patients with different forms of atrial fibrillation (p<0.001). Deceased patients with first diagnosed atrial fibrillation were significantly older and had a more pronounced degree of neurological deficit by NIHSS scale. Conclusion. The data obtained showed high prevalence and poor prognosis newly diagnosed with atrial fibrillation in patients with cardioembolic stroke. The use of the term “newly diagnosed stroke-associated atrial fibrillation” logically justified, which determines how the time of onset of this arrhythmia and high risk of mortality in patients of this group.

 

 

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The authors declare that there are no conflicts of interest present.