Atrial Fibrillation Known Before or Detected After Stroke Share Similar Risk of Ischemic Stroke Recurrence and Death

Yang, Xiaomeng; Rao, Zhenzhen; Gu, Hongqiu; Zhao, Xingquan; Wang, Chunjuan; Liu, Liping; Liu, Chelsea; Wang, Yilong; Li, Zixiao; Xiao, Rui‐Ping; Wang, Yongjun

doi:10.1161/strokeaha.118.024176

Cited by 53 publications

(52 citation statements)

References 31 publications

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“…In our study, patients with early AF detection had more atrial dysfunction assessed by different surrogates (LAVI, BNP). Moreover, no difference was found regarding the involvement of insular brain area in relation to new onset AF in contrast to other studies [13]. Our results are not applicable to patients below 55 years because they were excluded from the study.…”

Section: Discussioncontrasting

confidence: 95%

Large vessel occlusion is independently associated with atrial fibrillation detection

Pagola

Juega

Francisco‐Pascual

et al. 2020

Euro J of Neurology

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Background and purpose Covert paroxysmal atrial fibrillation (pAF) is the most frequent cause of cardiac embolism. Our goal was to discover parameters associated with early pAF detection with intensive cardiac monitoring. Method Crypto‐AF was a multicentre prospective study (four Comprehensive Stroke Centres) to detect pAF in non‐lacunar cryptogenic stroke continuously monitored within the first 28 days. Stroke severity, infarct pattern, large vessel occlusion (LVO) at baseline, electrocardiography analysis, supraventricular extrasystolia in the Holter examination, left atrial volume index and brain natriuretic peptide level were assessed. The percentage of pAF detection and pAF episodes lasting more than 5 h were registered. Results Out of 296 patients, 264 patients completed the monitoring period with 23.1% (61/264) of pAF detection. Patients with pAF were older [odds ratio (OR) 1.04, 95% confidence interval (CI) 1.01–1.08], they had more haemorrhagic infarction (OR 4.03, 95% CI 1.44–11.22), they were more likely to have LVO (OR 4.29, 95% CI 2.31–7.97) (P < 0.0001), they had a larger left atrial volume index (OR 1.03, 95% CI 1.01–1.1) (P = 0.0002) and they had a higher level of brain natriuretic peptide (OR 1.01, 95% CI 1.0–1.1). Age and LVO were independently associated with pAF detection (OR 1.06, 95% CI 1.00–1.16, and OR 4.58, 95% CI 2.27– 21.38, respectively). Patients with LVO had higher cumulative incidence of pAF (log rank P < 0.001) and more percentage of pAF > 5 h [29.6% (21/71) vs. 8.3% (12/144); OR 4.62, 95% CI 2.11–10.08; P < 0.001]. In a mean follow‐up of 26.82 months (SD 10.15) the stroke recurrence rate was 4.6% (12/260). Conclusions Large vessel occlusion in cryptogenic stroke emerged as an independent marker of pAF.

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Section: Discussioncontrasting

confidence: 95%

Large vessel occlusion is independently associated with atrial fibrillation detection

Pagola

Juega

Francisco‐Pascual

et al. 2020

Euro J of Neurology

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“…AF is also associated with a higher risk stroke recurrence, whether it is atrial fibrillation diagnosed after stroke or atrial fibrillation known before stroke. 17 It is interesting to note that the prevalence of AF in our group of ischemic stroke was around 8%, significantly lower than that reported internationally which can reach as high as one third of stroke cases. 18 Whether this represents a general lower incidence of AF in our population or more efficient management of existing AF with anticoagulation leading to a lower incidence of thrombotic complications remains unclear.…”

Section: Discussioncontrasting

confidence: 62%

Clinical Profile of Stroke Patients Presenting to the Emergency Department of a Major Stroke Centre in Oman

Harthi

Kashmiri

Zakaryia

et al. 2022

Sultan Qaboos Univ Med J

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Objectives: Stroke is a significant public health problem and one of the important preventable non-communicable diseases. Preventive stroke programs are yet to be properly established in Oman, with a better focus on increasing awareness among those who are currently at risk. This study was conducted to describe the characteristics of stroke presenting to a tertiary care hospital in Oman. Methods: This was a cross-sectional hospital-based study. Included 193 stroke cases which were prospectively recruited from the Emergency Department of a tertiary-level hospital. Data was collected from November 2017 to April 2018. Results: The total number of patients was 193. 82.9% of strokes were ischemic strokes. 58% were male. The mean age of stroke patients was 61.05 years. Risk factors included hypertension (72.5%) and diabetes mellitus (54.4%). Dyslipidemia, atrial fibrillation and ischemic heart diseases were not particularly prevalent in our population. 24.4% of ischemic strokes had large artery atherosclerosis and 21.9% had small vessel occlusion. Significantly more patients had lower Glasgow Coma Scale (GCS), required ICU admission and had in-hospital deaths in hemorrhagic stroke compared to ischemic stroke. Conclusions: This study provides essential stroke characteristics data specific to Oman’s population. Most of the information obtained conforms with that described internationally and similar preventive strategies can be implemented. The information can be utilized by health administrators in planning resource allocation. Further research is needed to explore rehabilitation aspects and long-term outcomes. Keywords: Stroke; Ischemic; Hemorrhagic; Young Stroke; Risk Factors; Thrombolysis; Epidemiology; Oman.

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“…Finally, the external generalizability of our findings is limited as participants were restricted to Chinese patients. Selection bias may also exist as the low proportion of atrial fibrillation (7.0% in CNSR-III vs. 9.6% in CNSR-II 31 ) and rate of death (3.2% in CNSR-III vs. 8.4% in CNSR-II 31 ) were observed in this population. Further validation was required in other populations or settings.…”

Section: Discussionmentioning

confidence: 86%

Residual Risk and Its Risk Factors for Ischemic Stroke with Adherence to Guideline-Based Secondary Stroke Prevention

Pan

et al. 2021

J Stroke

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Background and Purpose Despite administration of evidence-based therapies, residual risk of stroke recurrence persists. This study aimed to evaluate the residual risk of recurrent stroke in acute ischemic stroke or transient ischemic attack (TIA) with adherence to guideline-based secondary stroke prevention and identify the risk factors of the residual risk.Methods Patients with acute ischemic stroke or TIA within 7 hours were enrolled from 169 hospitals in Third China National Stroke Registry (CNSR-III) in China. Adherence to guideline-based secondary stroke prevention was defined as persistently receiving all of the five secondary prevention medications (antithrombotic, antidiabetic and antihypertensive agents, statin and anticoagulants) during hospitalization, at discharge, at 3, 6, and 12 months if eligible. The primary outcome was a new stroke at 12 months.Results Among 9,022 included patients (median age 63.0 years and 31.7% female), 3,146 (34.9%) were identified as adherence to guideline-based secondary prevention. Of all, 864 (9.6%) patients had recurrent stroke at 12 months, and the residual risk in patients with adherence to guidelinebased secondary prevention was 8.3%. Compared with those without adherence, patients with adherence to guideline-based secondary prevention had lower rate of recurrent stroke (hazard ratio, 0.85; 95% confidence interval, 0.74 to 0.99; P=0.04) at 12 months. Female, history of stroke, interleukin-6 ≥5.63 ng/L, and relevant intracranial artery stenosis were independent risk factors of the residual risk.Conclusions There was still a substantial residual risk of 12-month recurrent stroke even in patients with persistent adherence to guideline-based secondary stroke prevention. Future research should focus on efforts to reduce the residual risk.

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Atrial Fibrillation Known Before or Detected After Stroke Share Similar Risk of Ischemic Stroke Recurrence and Death

Cited by 53 publications

References 31 publications

Large vessel occlusion is independently associated with atrial fibrillation detection

Large vessel occlusion is independently associated with atrial fibrillation detection

Clinical Profile of Stroke Patients Presenting to the Emergency Department of a Major Stroke Centre in Oman

Residual Risk and Its Risk Factors for Ischemic Stroke with Adherence to Guideline-Based Secondary Stroke Prevention

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