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 language | English |
|---|---|
| Pages (from-to) | 55-64 |
| Number of pages | 10 |
| Journal | European Stroke Journal |
| Volume | 4 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - Mar 1 2019 |
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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 journal › Article
}
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
UR - http://www.scopus.com/inward/record.url?scp=85062741180&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85062741180&partnerID=8YFLogxK
U2 - 10.1177/2396987318785853
DO - 10.1177/2396987318785853
M3 - Article
AN - SCOPUS:85062741180
VL - 4
SP - 55
EP - 64
JO - European Stroke Journal
JF - European Stroke Journal
SN - 2396-9873
IS - 1
ER -