Association of atrial fibrillation with mortality and disability after ischemic stroke

McGrath, Emer R.; Kapral, Moira K.; Fang, Jiming; Eikelboom, John W.; O’Conghaile, Aengus; Canavan, Michelle; O’Donnell, Martin J.

doi:10.1212/wnl.0b013e3182a2cc15

Cited by 112 publications

(68 citation statements)

References 24 publications

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“…Thus, we have found that CEI on the background of AF is associated with the highest mortality and the most severe neurological deficit in acute phase that coincides with the data of other authors [7]. Patients with LAC in the acute phase had less neurological deficit that had been proved by the results of other studies [8].…”

supporting

confidence: 91%

Clinical neurological characteristics of ischemic stroke subtypes in acute phase

Shkrobot¹,

Sokhor²,

Milevska-Vovchuk³

et al. 2018

ZMJ

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Objectives. The aim of the present study was to clarify clinical neurological characteristics and different ischemic stroke subtypes unfavorable course predictors in acute phase.Material and methods. 482 patients with different ischemic stroke subtypes were observed. Among them there were 125 (25.9 %) with cardioembolic infarct (CEI), 119 (24.7 %) with large artery atherosclerosis (LAAS) infarct, 122 (25.3 %) with lacunar stroke (LAC), 116 (24.1 %) with stroke of undetermined etiology (UDE). The comparative analysis of clinical picture was performed. The predictors of unfavorable course of acute phase were established.Results. We have found out that severe neurological deficit, high mortality and the worst functional outcome during the first 14 days were observed in patients with CEI and LAAS. The highest frequency of early neurological deterioration (END) was detected at LAC (in 22.7 % of patients). There was a relationship between END and presence of transient ischemic attack (TIA) in past medical history, the level of systolic blood pressure (SBP) at the beginning of the disease and the degree of carotid arteries stenosis on the side of lesion. The patients with LAC had mild neurological deficit and better prognosis compared with other ischemic stroke subtypes. Among the clinical factors that have impact on the CEI, LAAS and UDE acute phase course were: the size of lesion, the level of consciousness on the 1st day, the baseline SBP, patient's age. At LAAS, the presence of transient ischemic attack (TIA) in past medical history and low SBP in the onset of the disease (less than 140 mm Hg) has an additional prognostic value for an unfavorable functional outcome. The severity of LAC in acute period depended on its localization and size. Localization of LAC in the internal capsule, thalamus and pons were characterized by the highest severity. Conclusions.Clinical neurological features of ischemic stroke depend on its subtype and have some prognostic value for the course of different ischemic stroke subtypes in acute phase.Клініко-неврологічні особливості перебігу підтипів ішемічного інсульту в гострому періодіМета роботи -уточнити клініко-неврологічні особливості та предиктори несприятливого перебігу різних підтипів ішемічного інсульту в гострому періоді.Матеріали та методи. У 482 осіб із різними підтипами ішемічного інсульту (125 (25,9 %) з кардіоемболічним інсультом (КЕІ), 119 (24,7 %) -з атеротромботичним інсультом (АТІ), 122 (25,3 %) -з лакунарним інсультом (ЛІ) та у 116 (24,1 %) пацієнтів -з інсультом невизначеної етіології (ІНЕ) здійснили порівняльну характеристику особливостей клінічної симптоматики та визначили предиктори несприятливого перебігу гострого періоду.Результати. Встановили, що найтяжчий неврологічний дефіцит, найвища смертність і гірший функціональний резуль-тат протягом перших 14 днів захворювання спостерігались при КЕІ та АТІ. Найвища частота раннього неврологічного погіршання (РНП) виявлена при АТІ (у 22,7 % пацієнтів). Спостерігалась залежність між РНП із наявністю в анамнезі транзиторної ...

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supporting

confidence: 91%

Clinical neurological characteristics of ischemic stroke subtypes in acute phase

Shkrobot¹,

Sokhor²,

Milevska-Vovchuk³

et al. 2018

ZMJ

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“…This might be because of more severe strokes and more complications after stroke in people with atrial fibrillation. 41 For people with underweight, the increased risk of death after stroke might be because of frailty in combination with dysphagia. 37,42 Underweight participants might be more vulnerable to undernutrition.…”

Section: Discussionmentioning

confidence: 99%

Role of Prestroke Vascular Pathology in Long-Term Prognosis After Stroke

Portegies

Bos

Hofman

et al. 2016

Stroke

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Background and Purpose-Mortality after stroke remains high for years, mostly because of cardiovascular causes. Given that cardiovascular pathology plays an important role in causing the initial stroke, such prestroke pathology might also influence the prognosis after stroke. Within the population-based Rotterdam Study, we examined the proportion of deaths after stroke that are attributable to pre-existent cardiovascular risk factors before stroke (the population attributable risk). Methods-We examined 1237 patients with first-ever stroke and 4928 stroke-free participants (between 1990 and 2012), matched on age, sex, examination round, and stroke date (index date). Cardiovascular risk factors measured on ≈4 years before index date were used as determinants. Participants were continuously followed up for mortality (≈6 years) after the index date. We calculated separate and combined population attributable risk of hypertension, total cholesterol, high-density lipoprotein-cholesterol, body mass index, diabetes mellitus, smoking, transient ischemic attack, and atrial fibrillation. Results-Nine hundred and nineteen patients with stroke and 2654 stroke-free participants died. The combined population attributable risk in patients with stroke was 27% (95% confidence interval, 14%-45%) and in stroke-free participants was 19% (95% confidence interval, 12%-29%). Population attributable risks of diabetes mellitus, smoking, and atrial fibrillation were higher in patients with stroke than in the reference group because of a higher prevalence of risk factors. In addition, people with atrial fibrillation and stroke had a higher hazard ratio for death than those with only atrial fibrillation. Conclusions-One quarter of deaths after stroke could theoretically be prevented with rigorous cardiovascular prevention and treatment, but this should preferably start before stroke occurrence. In addition, research into factors explaining the remaining deaths needs to be encouraged.

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“…136 Warfarin treatment for NVAF is also associated with reduced all-cause mortality 136 and reduced ischemic stroke severity. [137][138][139] Anticoagulation with NOACs appears at least equally effective as anticoagulation with warfarin for ischemic stroke prevention. A meta-analysis of 42 411 NVAF trial subjects assigned to the NOACs dabigatran, apixaban, rivaroxaban, and edoxaban versus 29 272 assigned to warfarin found nonsignificantly fewer ischemic strokes with NOAC treatment (RR versus warfarin, 0.92; 95% CI, 0.83-1.02).…”

Section: Anticoagulation and Other Medical Therapies In Patients Withmentioning

confidence: 99%

Prevention of Stroke in Patients With Silent Cerebrovascular Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

Smith¹,

Saposnik²,

Biessels³

et al. 2017

Stroke

294

297

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Abstract-Two decades of epidemiological research shows that silent cerebrovascular disease is common and is associated with future risk for stroke and dementia. It is the most common incidental finding on brain scans. To summarize evidence on the diagnosis and management of silent cerebrovascular disease to prevent stroke, the Stroke Council of the American Heart Association convened a writing committee to evaluate existing evidence, to discuss clinical considerations, and to offer suggestions for future research on stroke prevention in patients with 3 cardinal manifestations of silent cerebrovascular disease: silent brain infarcts, magnetic resonance imaging white matter hyperintensities of presumed vascular origin, and cerebral microbleeds. The writing committee found strong evidence that silent cerebrovascular disease is a common problem of aging and that silent brain infarcts and white matter hyperintensities are associated with future symptomatic stroke risk independently of other vascular risk factors. In patients with cerebral microbleeds, there was evidence of a modestly increased risk of symptomatic intracranial hemorrhage in patients treated with thrombolysis for acute ischemic stroke but little prospective evidence on the risk of symptomatic hemorrhage in patients on anticoagulation. There were no randomized controlled trials targeted specifically to participants with silent cerebrovascular disease to prevent stroke. Primary stroke prevention is indicated in patients with silent brain infarcts, white matter hyperintensities, or microbleeds. Adoption of standard terms and definitions for silent cerebrovascular disease, as provided by prior American Heart Association/American Stroke Association statements and by a consensus group, may facilitate diagnosis and communication of findings from radiologists to clinicians. (Stroke. 2017;48:e44-e71.

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Association of atrial fibrillation with mortality and disability after ischemic stroke

Cited by 112 publications

References 24 publications

Clinical neurological characteristics of ischemic stroke subtypes in acute phase

Clinical neurological characteristics of ischemic stroke subtypes in acute phase

Role of Prestroke Vascular Pathology in Long-Term Prognosis After Stroke

Prevention of Stroke in Patients With Silent Cerebrovascular Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

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