Sinus node dysfunction and stroke risk: a systematic review and meta-analysis
Objectives The role of cardiac arrhythmia in ischaemic stroke is widely studied, but the size of the stroke risk in patients with sinus node dysfunction (SND) with and without atrial fibrillation (AF) is unclear. This systematic review and meta-analysis aimed to compare the risk of stroke and its as...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-11-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/11/e076499.full |
| _version_ | 1797428512390381568 |
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| author | Yunlong Xia Hao Chen Xiaolei Yang Tesfaldet Habtemariam Hidru Haoyu Dong |
| author_facet | Yunlong Xia Hao Chen Xiaolei Yang Tesfaldet Habtemariam Hidru Haoyu Dong |
| author_sort | Yunlong Xia |
| collection | DOAJ |
| description | Objectives The role of cardiac arrhythmia in ischaemic stroke is widely studied, but the size of the stroke risk in patients with sinus node dysfunction (SND) with and without atrial fibrillation (AF) is unclear. This systematic review and meta-analysis aimed to compare the risk of stroke and its associated factors in patients with SND with and without AF.Design A systematic review and meta-analysis was conducted based on the Grading of Recommendations, Assessment, Development and Evaluation approach.Data sources PubMed, EMBASE and Cochrane Database were searched until December 2022.Eligibility criteria for selecting studies Studies that investigate stroke in patients with SND diagnosed with or without AF/atrial flutter.Data extraction and synthesis Two independent authors screened studies for inclusion and extracted data. Literature quality assessment was performed using the Newcastle-Ottawa Scale and the Cochrane Collaboration Tool. The overall risk of stroke was estimated using the random-effects model. The generic inverse variance method was used to calculate the pooled estimates of stroke-associated factors. We performed a sensitivity analysis using a fixed-effects model.Results Of the 929 records retrieved, 6 papers (106 163 patients) met the inclusion criteria. The average yearly stroke incidence in patients with SND was 1.542% (95% CI: 1.334% to 1.749%). The stroke incidence was similar between the isolated SND (1.587%; 95% CI: 1.510% to 1.664%) and non-isolated (SND+AF) (1.660%; 95% CI: 0.705% to 2.615%) groups. AF (HR, 95% CI: 1.53 (1.01 to 2.33)), stroke/transient ischaemia attack/other thrombotic events (HR, 95% CI: 2.54 (1.14 to 5.69)), hypertension (HR, 95% CI: 1.51 (1.11 to 2.07)) and heart failure (HR, 95% CI: 1.41 (1.01 to 1.97)) were associated with stroke in the SND population.Conclusion Our findings suggest that patients with SND carry a similar risk of stroke to those with combined SND and AF. Future studies are needed to investigate whether interventions targeting stroke prevention, such as anticoagulation therapy, can help to prevent stroke in patients with SND.PROSPERO registration number CRD42023408436. |
| first_indexed | 2024-03-09T08:59:57Z |
| format | Article |
| id | doaj.art-2d78688d4bc641bd80fea3b2ed8fe152 |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-03-09T08:59:57Z |
| publishDate | 2023-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-2d78688d4bc641bd80fea3b2ed8fe1522023-12-02T11:50:08ZengBMJ Publishing GroupBMJ Open2044-60552023-11-01131110.1136/bmjopen-2023-076499Sinus node dysfunction and stroke risk: a systematic review and meta-analysisYunlong Xia0Hao Chen1Xiaolei Yang2Tesfaldet Habtemariam Hidru3Haoyu Dong4Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, ChinaDepartment of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, ChinaDepartment of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, ChinaDepartment of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, ChinaDepartment of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, ChinaObjectives The role of cardiac arrhythmia in ischaemic stroke is widely studied, but the size of the stroke risk in patients with sinus node dysfunction (SND) with and without atrial fibrillation (AF) is unclear. This systematic review and meta-analysis aimed to compare the risk of stroke and its associated factors in patients with SND with and without AF.Design A systematic review and meta-analysis was conducted based on the Grading of Recommendations, Assessment, Development and Evaluation approach.Data sources PubMed, EMBASE and Cochrane Database were searched until December 2022.Eligibility criteria for selecting studies Studies that investigate stroke in patients with SND diagnosed with or without AF/atrial flutter.Data extraction and synthesis Two independent authors screened studies for inclusion and extracted data. Literature quality assessment was performed using the Newcastle-Ottawa Scale and the Cochrane Collaboration Tool. The overall risk of stroke was estimated using the random-effects model. The generic inverse variance method was used to calculate the pooled estimates of stroke-associated factors. We performed a sensitivity analysis using a fixed-effects model.Results Of the 929 records retrieved, 6 papers (106 163 patients) met the inclusion criteria. The average yearly stroke incidence in patients with SND was 1.542% (95% CI: 1.334% to 1.749%). The stroke incidence was similar between the isolated SND (1.587%; 95% CI: 1.510% to 1.664%) and non-isolated (SND+AF) (1.660%; 95% CI: 0.705% to 2.615%) groups. AF (HR, 95% CI: 1.53 (1.01 to 2.33)), stroke/transient ischaemia attack/other thrombotic events (HR, 95% CI: 2.54 (1.14 to 5.69)), hypertension (HR, 95% CI: 1.51 (1.11 to 2.07)) and heart failure (HR, 95% CI: 1.41 (1.01 to 1.97)) were associated with stroke in the SND population.Conclusion Our findings suggest that patients with SND carry a similar risk of stroke to those with combined SND and AF. Future studies are needed to investigate whether interventions targeting stroke prevention, such as anticoagulation therapy, can help to prevent stroke in patients with SND.PROSPERO registration number CRD42023408436.https://bmjopen.bmj.com/content/13/11/e076499.full |
| spellingShingle | Yunlong Xia Hao Chen Xiaolei Yang Tesfaldet Habtemariam Hidru Haoyu Dong Sinus node dysfunction and stroke risk: a systematic review and meta-analysis BMJ Open |
| title | Sinus node dysfunction and stroke risk: a systematic review and meta-analysis |
| title_full | Sinus node dysfunction and stroke risk: a systematic review and meta-analysis |
| title_fullStr | Sinus node dysfunction and stroke risk: a systematic review and meta-analysis |
| title_full_unstemmed | Sinus node dysfunction and stroke risk: a systematic review and meta-analysis |
| title_short | Sinus node dysfunction and stroke risk: a systematic review and meta-analysis |
| title_sort | sinus node dysfunction and stroke risk a systematic review and meta analysis |
| url | https://bmjopen.bmj.com/content/13/11/e076499.full |
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