Prolonged cardiac monitoring for stroke prevention: A systematic review and meta-analysis of randomized-controlled clinical trials.

Autor:	Tsivgoulis G; Second Department of Neurology, 'Attikon' University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.; Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA., Palaiodimou L; Second Department of Neurology, 'Attikon' University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece., Triantafyllou S; Second Department of Neurology, 'Attikon' University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece., Köhrmann M; Department of Neurology, Universitätsklinikum Essen, Essen, Germany., Dilaveris P; First Department of Cardiology, National and Kapodistrian University of Athens, School of Medicine, Hippokration Hospital, Athens, Greece., Tsioufis K; First Department of Cardiology, National and Kapodistrian University of Athens, School of Medicine, Hippokration Hospital, Athens, Greece., Magiorkinis G; Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece., Krogias C; Department of Neurology, St. Josef-Hospital, Ruhr University, Bochum, Germany., Schellinger PD; Department of Neurology and Neurogeriatry, Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany., Caso V; Stroke Unit, Santa Maria Della Misericordia Hospital, University of Perugia, Perugia, Italy., Paciaroni M; Stroke Unit, Santa Maria Della Misericordia Hospital, University of Perugia, Perugia, Italy., Sharma M; Division of Neurology, McMaster University and Population Health Research Institute, Hamilton, ON, Canada., Lemmens R; Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven - University of Leuven, Leuven, Belgium.; Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium.; Department of Neurology, University Hospitals Leuven, Leuven, Belgium., Gladstone DJ; Sunnybrook Research Institute and Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.; Department of Medicine, University of Toronto, Toronto, ON, Canada., Sanna T; Fondazione Policlinico Gemelli IRCCS, Rome, Italy.; Catholic University of the Sacred Heart, Institute of Cardiology, Rome, Italy., Wachter R; Department of Cardiology, University Hospital Leipzig, Leipzig, Germany.; Clinic for Cardiology and Pneumology, University Medicine Göttingen, Germany.; German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany., Filippatos G; Second Department of Cardiology, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece., Katsanos AH; Division of Neurology, McMaster University and Population Health Research Institute, Hamilton, ON, Canada.
Jazyk:	angličtina
Zdroj:	European stroke journal [Eur Stroke J] 2023 Mar; Vol. 8 (1), pp. 106-116. Date of Electronic Publication: 2022 Nov 21.
DOI:	10.1177/23969873221139410
Abstrakt:	Introduction: Prolonged cardiac monitoring (PCM) substantially improves the detection of subclinical atrial fibrillation (AF) among patients with history of ischemic stroke (IS), leading to prompt initiation of anticoagulants. However, whether PCM may lead to IS prevention remains equivocal. Patients and Methods: In this systematic review and meta-analysis, randomized-controlled clinical trials (RCTs) reporting IS rates among patients with known cardiovascular risk factors, including but not limited to history of IS, who received PCM for more than 7 days versus more conservative cardiac rhythm monitoring methods were pooled. Results: Seven RCTs were included comprising a total of 9048 patients with at least one known cardiovascular risk factor that underwent cardiac rhythm monitoring. PCM was associated with reduction of IS occurrence compared to conventional monitoring (Risk Ratio: 0.76; 95% CI: 0.59-0.96; I 2  = 0%). This association was also significant in the subgroup of RCTs investigating implantable cardiac monitoring (Risk Ratio: 0.75; 95% CI: 0.58-0.97; I 2  = 0%). However, when RCTs assessing PCM in both primary and secondary prevention settings were excluded or when RCTs investigating PCM with a duration of 7 days or less were included, the association between PCM and reduction of IS did not retain its statistical significance. Regarding the secondary outcomes, PCM was related to higher likelihood for AF detection and anticoagulant initiation. No association was documented between PCM and IS/transient ischemic attack occurrence, all-cause mortality, intracranial hemorrhage, or major bleeding. Conclusion: PCM may represent an effective stroke prevention strategy in selected patients. Additional RCTs are warranted to validate the robustness of the reported associations. Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. (© European Stroke Organisation 2022.)
Databáze:	MEDLINE
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