Stroke：阵发性室上性心动过速与缺血性卒中独立相关

　　美国一项研究表明，阵发性室上性心动过速（PSVT）与缺血性卒中呈独立相关，PSVT可能为卒中的新型危险因素。论文4月30日在线发表于《卒中》（Stroke）。

　　此项回顾性队列研究利用急诊和住院保险索赔资料确认了相关患者。主要暴露指标为卒中发生前或卒中就诊时伴有PSVT诊断。排除伴有房颤诊断的患者亦减少混淆。利用ICD-9确定PSVT、卒中和房颤。

　　结果显示，共有4806830例适宜患者被纳入研究，其中14121例（0.29%）被诊断为PSVT，14402例（0.30%）出现卒中。PSVT诊断后卒中累积发生率显著高于无PSVT患者的发生率（0.94%对0.21%）。对人口统计学特征和前瞻混淆因素进行校正之后，Cox比例风险分析显示PSVT与后续卒中风险升高独立相关（危险比2.10）。

与卒中相关的拓展阅读：

• Stroke：糖尿病患者缺血性卒中风险或无种族差异
• 专家讲座：急性缺血性卒中静脉溶栓中美建议比照
• NEJM：肠道细菌副产物可预测心脏病与卒中风险
• AAN 2013：卒中氧疗研究过早终止
• Stroke：缺血性卒中后慢性疼痛综合征常见 更多信息请点击：有关卒中更多资讯

Paroxysmal Supraventricular Tachycardia and the Risk of Ischemic Stroke
Background and Purpose
It is unknown whether supraventricular arrhythmias other than atrial fibrillation or flutter are associated with stroke.
Methods
To examine the association between paroxysmal supraventricular tachycardia (PSVT) and stroke, we performed a retrospective cohort study using administrative claims data from all emergency department encounters and hospitalizations at California’s nonfederal acute care hospitals in 2009. Our cohort comprised all adult patients with ≥1 emergency department visit or hospitalization from which they were discharged alive and without a diagnosis of stroke. Our primary exposure was a diagnosis of PSVT recorded at an encounter before stroke or documented as present-on-admission at the time of stroke. To reduce confounding, we excluded patients with diagnoses of atrial fibrillation. We defined PSVT, stroke, and atrial fibrillation using International Classification of Diseases, Ninth Revision, Clinical Modification codes previously validated by detailed chart review.
Results
Of 4 806 830 eligible patients, 14 121 (0.29%) were diagnosed with PSVT and 14 402 (0.30%) experienced a stroke. The cumulative rate of stroke after PSVT diagnosis (0.94%; 95% confidence interval, 0.76%–1.16%) significantly exceeded the rate among patients without a diagnosis of PSVT (0.21%; 95% confidence interval, 0.21%–0.22%). In Cox proportional hazards analysis controlling for demographic characteristics and potential confounders, PSVT was independently associated with a higher risk of subsequent stroke (hazard ratio, 2.10; 95% confidence interval, 1.69–2.62).
Conclusions
In a large and demographically diverse sample of patients, we found an independent association between PSVT and ischemic stroke. PSVT seems to be a novel risk factor that may account for some proportion of strokes that are
currently classified as cryptogenic.