ROCKET-AF研究结果解读.ppt

房颤是卒中强烈的独立危险因素 AF的患病率 AF 是一种高发疾病1–6 抗凝剂与房颤风险因素 (ATRIA) 研究 – 美国的患病率估计在1％左右1 在美国，大约有230万房颤患者，在欧洲为450万1,7 在中国， AF患病率在男性中为 1.4% ，在女性中为 0.7 % 8，总共约800万人 AF患者的数量预计还会增加 ESC 2010指南推荐 重大危险因素: 既往脑卒中, TIA 或系统性栓塞史 年龄 ≥ 75 岁 临床相关非危大风险因素: 心衰或中重度LV收缩功能障碍 (如 LV EF 40%) 高血压 糖尿病 女性 年龄 65–74 岁 患有血管疾病 The Framingham Heart Study evaluated the impact of the presence or absence of coronary heart disease, hypertension, heart failure, and non-rheumatic AF on the incidence of stroke This analysis demonstrated that the presence of coronary heart disease more than doubled the risk of stroke (risk ratio 2.4), the presence of hypertension more than tripled the risk of stroke (risk ratio 3.4) and heart failure more than quadrupled the risk of stroke (risk ratio 4.3). However, of all these factors, AF was the most important independent risk factor for stroke, increasing stroke risk almost 5-fold (risk ratio 4.8) AF is associated with a risk of thrombus formation in the left atrium. Such thrombi can embolize to the brain, resulting in an ischemic stroke. The pathogenesis of intra-cardiac thrombus formation in patients with AF is multifactorial and relates to the fulfilment of Virchow’s classic triad (stasis of blood in fibrillating atria, atrial endocardial damage and abnormal changes in blood constituents), which together perpetuate a hypercoaguable state Abbreviation AF, atrial fibrillation References Wolf et al. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke 1991;22:983–988. Watson et al. Mechanisms of thrombogenesis in atrial fibrillation: Virchow’s triad revisited. Lancet 2009;373:155–166. Prevalence of AF Over the past decade, several studies have assessed the prevalence/incidence of AF in different populations and countries across the world1–6 Perhaps one of the most often cited studies is the US AnTicoagulation and Risk factors In Atrial fibrillation (ATRIA) study:1 The ATRIA study was a cross-sectional