We aimed to evaluate the long-term risk of ischemic stroke/systemic embolism of hyperthyroidism-related AF. This retrospective population-based cohort study included records of 1,034,099 atrial fibrillation patients between 2005 and 2016 from the Korean National Health Insurance Service database. After exclusion, we identified 615,724 oral anticoagulation-naïve patients aged ≥18 years with new-onset non-valvular atrial fibrillation, of whom 20,773 had hyperthyroidism-related atrial fibrillation. After 3:1 propensity score matching, ischemic stroke and systemic embolism occurrences were compared between hyperthyroidism-related and non-hyperthyroidism-related (“nonthyroidal”) atrial fibrillation patients. After exclusion, we identified 615,724 oral anticoagulation-naïve AF patients of whom 20,773 had hyperthyroidism-related AF. Median follow-up duration was 5.9 years. Hyperthyroidism-related AF patients had significantly higher risks of ischemic stroke and systemic embolism than nonthyroidal AF patients (1.83 vs 1.62 per 100-person year, hazard ratio[HR], 1.13; 95% confidence interval[CI], 1.07 to 1.19; < 0.001). This risk was 36% higher in hyperthyroidism-related than in nonthyroidal AF patients within 1 year of atrial fibrillation diagnosis (3.65 vs 2.67 per 100-person year, HR, 1.36; 95% CI, 1.24 – 1.50; < 0.001). This difference was also observed in the CHADS-VASc score subgroup analysis. The risk of ischemic stroke and systemic embolism significantly decreased in patients treated for hyperthyroidism (HR, 0.64; 95% CI, 0.58 to 0.70; < 0.001). Hyperthyroidism-related AF patients have high risks of ischemic stroke and systemic embolism like nonthyroidal AF, especially when initially diagnosed. This risk is reduced by treating hyperthyroidism.

中文翻译：

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甲状腺功能亢进相关心房颤动中缺血性中风和全身性栓塞的风险增加：一项全国性队列研究

我们的目的是评估甲状腺功能亢进相关房颤的缺血性卒中/全身性栓塞的长期风险。这项基于人群的回顾性队列研究纳入了韩国国民健康保险服务数据库 2005 年至 2016 年间 1,034,099 名房颤患者的记录。排除后，我们确定了 615,724 名年龄≥18 岁且未接受过口服抗凝药物的新发非瓣膜性房颤患者，其中 20,773 名患有甲状腺功能亢进相关房颤。经过 3:1 倾向评分匹配后，比较了甲状腺功能亢进相关和非甲状腺功能亢进相关（“非甲状腺”）心房颤动患者的缺血性卒中和全身性栓塞的发生率。排除后，我们确定了 615,724 名未接受口服抗凝治疗的 AF 患者，其中 20,773 名患有甲状腺功能亢进相关 AF。中位随访时间为 5.9 年。甲状腺机能亢进相关房颤患者发生缺血性卒中和全身性栓塞的风险显着高于非甲状腺房颤患者（每100人年1.83 vs 1.62，风险比[HR]，1.13；95%置信区间[CI]，1.07至1.19；< 0.001）。房颤诊断后 1 年内，甲状腺功能亢进相关患者的这一风险比非甲状腺 AF 患者高 36%（每 100 人年 3.65 vs 2.67，HR，1.36；95% CI，1.24 – 1.50；< 0.001）。 CHADS-VASc 评分亚组分析中也观察到了这种差异。接受甲状腺功能亢进症治疗的患者缺血性中风和全身性栓塞的风险显着降低（HR，0.64；95% CI，0.58至0.70；< 0.001）。甲状腺机能亢进相关房颤患者发生缺血性中风和全身性栓塞（如非甲状腺性房颤）的风险很高，尤其是在最初诊断时。通过治疗甲状腺功能亢进症可以降低这种风险。