| 심방세동환자에서 뇌경색 발생의 위험인자 |
| 박만석, 이승한, 정슬기, 김명규, 조기현, 김세종 |
| 전남대학교 의과대학 신경과학교실 |
| Risk Factors of Cerebral Infarction
in Patients with Atrial Fibrillation |
| Man-Suk Park, Seung-Han Lee, Xeul-Ki Chung,
Myeong-Kyu Kim, Ki-Hyun Cho, Sei-Jong Kim |
| Department of Neurology, College of Medicine
Chonnam National University Hospital |
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| Abstract |
Backgroudn : It is well known that atrial fibrillation is common cardiac arrythmia in old age and poses a definitive risk factor of cerebral infarction. Therefore, effective treatment of atrial fibrillation is very important in the prevention of cerebral infarction. However, oral anticoagulant medication for the prevention of embolic ischemic stroke may be dangerous due to cerebral hemorrhage side effects.
Methods: This is a controlled case study designed to identify the risk factors in a large numbers of stroke and atrial fibrillation patients and to assess those patients with atrial fibrillation as a high risk group for cerebral infarction. All patient discharged from Chonnam National University Hospital were identified over a 42 month period who met our case standards of atrial fibrillation and ischemic stroke (n=62), and compared them with the control groups who were discharged with atrial fibrillation without stroke(n=68). We excluded the atrial fibrillation due to valvular heart disease, ischemic heart disease and congestive heart failure during the selection of subjects.
Results: Subjects and the controls were characteristically similar with common past medical histories of diabets, smoking, and hyperlipidemia. Sex, familial history, left ventricular hypertrophy in 2D-echocardiogram were also similar in both groups, however differences did exist. Subjects were significantly older than controls(68.9 : 63.9, p<0.001) and more likely to have a history of hypertension(56.5% : 23.5%, p<0.001) and left atrial enlargement(>40mm)(52.6% : 29.0%, p<0.001). Each of these 3 factors were assinged a measure of 1 point as a risk score, ischemic embolic stroke was found in 4 out of 28 patients(14.3%) with a risk score of 0, in 16 out of 39 patients(41.0%) with a risk score of 1, in 29 out of 41 patients(70.7%) with a risk score of 2, in 8 out of 11 patients(72.7%) with a risk score of 3.
Conclusions: Based on the above results, a subject having more than two risk factors should be regarded as a high risk group for cerebral infarction and the long term anticoagulant therapy for the prevention of stroke may also be necessary even though some complications are present. Key Words: Stroke with atrial fibrillation, Hypertension, Old age, Left atrial enlargement, Long term anticoagulation therapy |
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