Early recurrence in paroxysmal versus sustained atrial fibrillation in patients with acute ischaemic stroke

Zedde Marialuisa

Research output: Contribution to journalArticle

Abstract

Background: The relationship between different patterns of atrial fibrillation and early recurrence after an acute ischaemic stroke is unclear. Purpose: In a prospective cohort study, we evaluated the rates of early ischaemic recurrence after an acute ischaemic stroke in patients with paroxysmal atrial fibrillation or sustained atrial fibrillation which included persistent and permanent atrial fibrillation. Methods: In patients with acute ischaemic stroke, atrial fibrillation was categorised as paroxysmal atrial fibrillation or sustained atrial fibrillation. Ischaemic recurrences were the composite of ischaemic stroke, transient ischaemic attack and symptomatic systemic embolism occurring within 90 days from acute index stroke. Results: A total of 2150 patients (1155 females, 53.7%) were enrolled: 930 (43.3%) had paroxysmal atrial fibrillation and 1220 (56.7%) sustained atrial fibrillation. During the 90-day follow-up, 111 ischaemic recurrences were observed in 107 patients: 31 in patients with paroxysmal atrial fibrillation (3.3%) and 76 with sustained atrial fibrillation (6.2%) (hazard ratio (HR) 1.86 (95% CI 1.24–2.81)). Patients with sustained atrial fibrillation were on average older, more likely to have diabetes mellitus, hypertension, history of stroke/ transient ischaemic attack, congestive heart failure, atrial enlargement, high baseline NIHSS-score and implanted pacemaker. After adjustment by Cox proportional hazard model, sustained atrial fibrillation was not associated with early ischaemic recurrences (adjusted HR 1.23 (95% CI 0.74–2.04)). Conclusions: After acute ischaemic stroke, patients with sustained atrial fibrillation had a higher rate of early ischaemic recurrence than patients with paroxysmal atrial fibrillation. After adjustment for relevant risk factors, sustained atrial fibrillation was not associated with a significantly higher risk of recurrence, thus suggesting that the risk profile associated with atrial fibrillation, rather than its pattern, is determinant for recurrence.

Original languageEnglish
Pages (from-to)55-64
Number of pages10
JournalEuropean Stroke Journal
Volume4
Issue number1
DOIs
Publication statusPublished - Mar 1 2019

Fingerprint

Atrial Fibrillation
Stroke
Recurrence
Transient Ischemic Attack
Embolism
Proportional Hazards Models
Diabetes Mellitus
Cohort Studies

Keywords

  • anticoagulation
  • atrial fibrillation
  • paroxysmal atrial fibrillation
  • Stroke
  • stroke recurrence
  • sustained atrial fibrillation

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Early recurrence in paroxysmal versus sustained atrial fibrillation in patients with acute ischaemic stroke. / Zedde Marialuisa.

In: European Stroke Journal, Vol. 4, No. 1, 01.03.2019, p. 55-64.

Research output: Contribution to journalArticle

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title = "Early recurrence in paroxysmal versus sustained atrial fibrillation in patients with acute ischaemic stroke",
abstract = "Background: The relationship between different patterns of atrial fibrillation and early recurrence after an acute ischaemic stroke is unclear. Purpose: In a prospective cohort study, we evaluated the rates of early ischaemic recurrence after an acute ischaemic stroke in patients with paroxysmal atrial fibrillation or sustained atrial fibrillation which included persistent and permanent atrial fibrillation. Methods: In patients with acute ischaemic stroke, atrial fibrillation was categorised as paroxysmal atrial fibrillation or sustained atrial fibrillation. Ischaemic recurrences were the composite of ischaemic stroke, transient ischaemic attack and symptomatic systemic embolism occurring within 90 days from acute index stroke. Results: A total of 2150 patients (1155 females, 53.7{\%}) were enrolled: 930 (43.3{\%}) had paroxysmal atrial fibrillation and 1220 (56.7{\%}) sustained atrial fibrillation. During the 90-day follow-up, 111 ischaemic recurrences were observed in 107 patients: 31 in patients with paroxysmal atrial fibrillation (3.3{\%}) and 76 with sustained atrial fibrillation (6.2{\%}) (hazard ratio (HR) 1.86 (95{\%} CI 1.24–2.81)). Patients with sustained atrial fibrillation were on average older, more likely to have diabetes mellitus, hypertension, history of stroke/ transient ischaemic attack, congestive heart failure, atrial enlargement, high baseline NIHSS-score and implanted pacemaker. After adjustment by Cox proportional hazard model, sustained atrial fibrillation was not associated with early ischaemic recurrences (adjusted HR 1.23 (95{\%} CI 0.74–2.04)). Conclusions: After acute ischaemic stroke, patients with sustained atrial fibrillation had a higher rate of early ischaemic recurrence than patients with paroxysmal atrial fibrillation. After adjustment for relevant risk factors, sustained atrial fibrillation was not associated with a significantly higher risk of recurrence, thus suggesting that the risk profile associated with atrial fibrillation, rather than its pattern, is determinant for recurrence.",
keywords = "anticoagulation, atrial fibrillation, paroxysmal atrial fibrillation, Stroke, stroke recurrence, sustained atrial fibrillation",
author = "{Zedde Marialuisa} and Maurizio Paciaroni and Filippo Angelini and Giancarlo Agnelli and Georgios Tsivgoulis and Furie, {Karen L.} and Prasanna Tadi and Cecilia Becattini and Nicola Falocci and Marialuisa Zedde and Abdul-Rahim, {Azmil H.} and Lees, {Kennedy R.} and Andrea Alberti and Michele Venti and Monica Acciarresi and Riccardo Altavilla and Cataldo D’Amore and Mosconi, {Maria G.} and Cimini, {Ludovica A.} and Paolo Bovi and Monica Carletti and Alberto Rigatelli and Manuel Cappellari and Jukka Putaala and Liisa Tomppo and Turgut Tatlisumak and Fabio Bandini and Simona Marcheselli and Alessandro Pezzini and Loris Poli and Alessandro Padovani and Luca Masotti and Vieri Vannucchi and Sohn, {Sung Il} and Gianni Lorenzini and Rossana Tassi and Francesca Guideri and Maurizio Acampa and Giuseppe Martini and George Ntaios and Efstathia Karagkiozi and George Athanasakis and Kostantinos Makaritsis and Kostantinos Vadikolias and Chrysoula Liantinioti and Maria Chondrogianni and Nicola Mumoli and Domenico Consoli and Simona Sacco and Antonio Carolei and Michelangelo Mancuso",
year = "2019",
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TY - JOUR

T1 - Early recurrence in paroxysmal versus sustained atrial fibrillation in patients with acute ischaemic stroke

AU - Zedde Marialuisa

AU - Paciaroni, Maurizio

AU - Angelini, Filippo

AU - Agnelli, Giancarlo

AU - Tsivgoulis, Georgios

AU - Furie, Karen L.

AU - Tadi, Prasanna

AU - Becattini, Cecilia

AU - Falocci, Nicola

AU - Zedde, Marialuisa

AU - Abdul-Rahim, Azmil H.

AU - Lees, Kennedy R.

AU - Alberti, Andrea

AU - Venti, Michele

AU - Acciarresi, Monica

AU - Altavilla, Riccardo

AU - D’Amore, Cataldo

AU - Mosconi, Maria G.

AU - Cimini, Ludovica A.

AU - Bovi, Paolo

AU - Carletti, Monica

AU - Rigatelli, Alberto

AU - Cappellari, Manuel

AU - Putaala, Jukka

AU - Tomppo, Liisa

AU - Tatlisumak, Turgut

AU - Bandini, Fabio

AU - Marcheselli, Simona

AU - Pezzini, Alessandro

AU - Poli, Loris

AU - Padovani, Alessandro

AU - Masotti, Luca

AU - Vannucchi, Vieri

AU - Sohn, Sung Il

AU - Lorenzini, Gianni

AU - Tassi, Rossana

AU - Guideri, Francesca

AU - Acampa, Maurizio

AU - Martini, Giuseppe

AU - Ntaios, George

AU - Karagkiozi, Efstathia

AU - Athanasakis, George

AU - Makaritsis, Kostantinos

AU - Vadikolias, Kostantinos

AU - Liantinioti, Chrysoula

AU - Chondrogianni, Maria

AU - Mumoli, Nicola

AU - Consoli, Domenico

AU - Sacco, Simona

AU - Carolei, Antonio

AU - Mancuso, Michelangelo

PY - 2019/3/1

Y1 - 2019/3/1

N2 - Background: The relationship between different patterns of atrial fibrillation and early recurrence after an acute ischaemic stroke is unclear. Purpose: In a prospective cohort study, we evaluated the rates of early ischaemic recurrence after an acute ischaemic stroke in patients with paroxysmal atrial fibrillation or sustained atrial fibrillation which included persistent and permanent atrial fibrillation. Methods: In patients with acute ischaemic stroke, atrial fibrillation was categorised as paroxysmal atrial fibrillation or sustained atrial fibrillation. Ischaemic recurrences were the composite of ischaemic stroke, transient ischaemic attack and symptomatic systemic embolism occurring within 90 days from acute index stroke. Results: A total of 2150 patients (1155 females, 53.7%) were enrolled: 930 (43.3%) had paroxysmal atrial fibrillation and 1220 (56.7%) sustained atrial fibrillation. During the 90-day follow-up, 111 ischaemic recurrences were observed in 107 patients: 31 in patients with paroxysmal atrial fibrillation (3.3%) and 76 with sustained atrial fibrillation (6.2%) (hazard ratio (HR) 1.86 (95% CI 1.24–2.81)). Patients with sustained atrial fibrillation were on average older, more likely to have diabetes mellitus, hypertension, history of stroke/ transient ischaemic attack, congestive heart failure, atrial enlargement, high baseline NIHSS-score and implanted pacemaker. After adjustment by Cox proportional hazard model, sustained atrial fibrillation was not associated with early ischaemic recurrences (adjusted HR 1.23 (95% CI 0.74–2.04)). Conclusions: After acute ischaemic stroke, patients with sustained atrial fibrillation had a higher rate of early ischaemic recurrence than patients with paroxysmal atrial fibrillation. After adjustment for relevant risk factors, sustained atrial fibrillation was not associated with a significantly higher risk of recurrence, thus suggesting that the risk profile associated with atrial fibrillation, rather than its pattern, is determinant for recurrence.

AB - Background: The relationship between different patterns of atrial fibrillation and early recurrence after an acute ischaemic stroke is unclear. Purpose: In a prospective cohort study, we evaluated the rates of early ischaemic recurrence after an acute ischaemic stroke in patients with paroxysmal atrial fibrillation or sustained atrial fibrillation which included persistent and permanent atrial fibrillation. Methods: In patients with acute ischaemic stroke, atrial fibrillation was categorised as paroxysmal atrial fibrillation or sustained atrial fibrillation. Ischaemic recurrences were the composite of ischaemic stroke, transient ischaemic attack and symptomatic systemic embolism occurring within 90 days from acute index stroke. Results: A total of 2150 patients (1155 females, 53.7%) were enrolled: 930 (43.3%) had paroxysmal atrial fibrillation and 1220 (56.7%) sustained atrial fibrillation. During the 90-day follow-up, 111 ischaemic recurrences were observed in 107 patients: 31 in patients with paroxysmal atrial fibrillation (3.3%) and 76 with sustained atrial fibrillation (6.2%) (hazard ratio (HR) 1.86 (95% CI 1.24–2.81)). Patients with sustained atrial fibrillation were on average older, more likely to have diabetes mellitus, hypertension, history of stroke/ transient ischaemic attack, congestive heart failure, atrial enlargement, high baseline NIHSS-score and implanted pacemaker. After adjustment by Cox proportional hazard model, sustained atrial fibrillation was not associated with early ischaemic recurrences (adjusted HR 1.23 (95% CI 0.74–2.04)). Conclusions: After acute ischaemic stroke, patients with sustained atrial fibrillation had a higher rate of early ischaemic recurrence than patients with paroxysmal atrial fibrillation. After adjustment for relevant risk factors, sustained atrial fibrillation was not associated with a significantly higher risk of recurrence, thus suggesting that the risk profile associated with atrial fibrillation, rather than its pattern, is determinant for recurrence.

KW - anticoagulation

KW - atrial fibrillation

KW - paroxysmal atrial fibrillation

KW - Stroke

KW - stroke recurrence

KW - sustained atrial fibrillation

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