Abstract: Objective To investigate the clinical characteristics and 1-year prognosis of first-ever cerebral infarction patients with atrial fibrillation (AF) in Xi'an. Methods Based on the Xi'an Stroke Register database, the first-ever cerebral infarction patients admitted to four 3A-grade hospitals in Xi 'an from January to December 2015 were included in this retrospective analysis. The patients were divided into non-AF group and AF group. The difference in basic clinical characteristics and 1-year poor outcome including stroke recurrence, poor functional outcome (mRS 2-5) and all-cause death between the two groups were compared. Multivariate logistic regression model was used to analyze the influence of AF on 1-year prognosis in first-ever cerebral infarction patients. Results A total of 1564 patients were included, including 113 patients (7.2%) with AF and 1451 patients (92.8%) without AF. Compared to the non-AF group, the patients in AF group showed

elder age [(71.18±12.66) years vs (63.25±12.46) years, P <0.001], higher body mass index [24.0

(22.0-25.5) kg/m2 vs 23.4 (21.1-24.6) kg/m2, P =0.004], lower rate of current smoking (11.5% vs 26.6%, P =0.002), higher NIHSS score at admission [7 (3-12) vs 4 (2-6), P <0.001], higher rate of secondary pneumonia (17.7% vs 3.7%, P <0.001), more patients unable to walk within 48 hours after admission (54.0% vs 32.9%, P <0.001), higher rate of dysphasia (14.2% vs 6.4%, P =0.001), and lower LDL-C level (2.44±0.71 mmol/L vs 2.65±0.86 mmol/L, P =0.016), higher INR (1.21±0.52 vs 1.02±0.13, P <0.001) and lower platelet count [(164.91±47.55)×109/L vs (192.58±59.98)×109/L, P <0.001]. Multivariate logistic regression analysis showed that the risks of poor functional outcome (OR 2.25, 95%CI 1.10-5.23, P =0.022) and death (OR 3.28, 95%CI 1.48-7.28, P =0.004) within 1 year in AF group were significantly higher than that in non-AF group, but there was no statistical difference in recurrent stroke risk between the groups (OR 1.14, 95%CI 0.34-3.85, P =0.833). Conclusions The partial clinical characteristics of first-ever cerebral infarction patients with AF were significantly different from that of patients without AF in Xi'an, and the risk of 1-year poor functional outcome and death increased significantly. It was suggested to evaluate the risk of stroke in AF patients and standardize anticoagulant therapy in high-risk patients.

Key words:   Atrial fibrillation; First-ever cerebral infarction; Clinical characteristics; Prognosis; Death; Stroke recurrence

摘要： 目的 探讨西安地区伴心房颤动（atrial fibrillation，AF）的首发脑梗死患者临床特征及1年预后情况。 方法 通过西安卒中登记研究，连续纳入2015年1-12月4所三级甲等医院确诊的首发脑梗死患者， 根据是否伴AF分为非AF组和AF组。比较两组基本临床特征和1年不良预后[卒中复发（脑梗死和脑出 血）、预后不良（mRS 2～5分）和全因死亡]发生率的差异。采用多因素logistic回归模型分析AF对首发 脑梗死患者1年预后的影响。 结果 共1564例首发脑梗死患者纳入研究，其中AF组113例（7.2%），非AF组1451例（92.8%）。AF 组平均年龄[71.18±12.66岁 vs 63.25±12.46岁，P <0.001]、BMI[24.0（22.0～25.5）kg/m2 vs 23.4 （21.1～24.6）kg/m2，P =0.004] 、目前仍吸烟比例（11.5% vs 26.6%，P =0.002）、入院NIHSS评分 [7（3～12）分 vs 4（2～6）分，P <0.001]、继发肺炎比例（17.7% vs 3.7%，P <0.001）、入院48 h 不能行走比例（54.0% vs 32.9%，P <0.001）、吞咽障碍比例（14.2% vs 6.4%，P =0.001）、LDL-C （2.44±0.71 mmol/L vs 2.65±0.86 mmol/L，P =0.016）、INR（1.21±0.52 vs 1.02±0.13，P <0.001）和 血小板计数[（164.91±47.55）×109/L vs（192.58±59.98）×109/L，P <0.001]等指标与非AF组相 比，差异均有统计学意义。多因素logistic回归分析显示，AF组患者的1年预后不良风险（OR 2.25， 95%CI 1.10～5.23，P =0.022）和死亡风险（OR 3.28，95%CI 1.48～7.28，P =0.004）较非AF组升高，两 组卒中复发风险差异无统计学意义（OR 1.14，95%CI 0.34～3.85，P =0.833）。 结论 西安地区伴AF的首发脑梗死患者部分临床特征显著区别于非AF组，1年预后不良风险和死 亡风险均显著升高。建议开展区域内AF患者卒中风险评估，以规范高危患者的抗凝治疗。

关键词: 心房颤动; 首发脑梗死; 临床特征; 预后; 死亡; 卒中复发