Afib: prior stroke and transient ischaemic attack predict subsequent stroke risk

  • Hacke W & al.
  • Int J Stroke
  • 17 Dec 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • In patients with atrial fibrillation (Afib), history of stroke or transient ischaemic attack (TIA) was associated with an increased risk for stroke/systemic embolism (SE) and mortality compared with those without any history.
  • This association was stronger in patients with a history of stroke or stroke and TIA and not those with a history of TIA.

Why this matters

  • Findings suggest that a history of TIA without stroke should be considered with caution for assessment of future risk in patients with newly diagnosed Afib.

Study design

  • Study included 5617 patients with a history of stroke or TIA using data from GARFIELD-AF registry.
  • The risks for mortality, stroke/SE and major bleeding were evaluated.
  • Funding: Thrombosis Research Institute, London, UK and Bayer AG, Berlin, Germany.

Key results

  • Of 5617 patients, 3362 (59.9%) had stroke, 1788 (31.8%) had TIA and 467 (8.3%) had stroke and TIA.
  • After adjusting for confounders, compared with patients not having any history of stroke/TIA, those with prior stroke/TIA were at an increased risk for:
    • all-cause (HR, 1.26; 95% CI, 1.12-1.42), cardiovascular (CV) mortality (sub-HR [SHR], 1.22; 95% CI, 1.01-1.48) and non-CV (SHR, 1.39; 95% CI, 1.15-1.68) mortality; and
    • stroke/SE (SHR, 2.17; 95% CI, 1.80-2.63).
  • Patients with prior stroke were at a higher risk for:
    • all-cause (HR, 1.29; 95% CI, 1.11-1.50) and non-CV (SHR, 1.39; 95% CI, 1.10-1.77) mortality; and
    • stroke/SE (HR, 2.29; 95% CI, 1.83-2.86).
  • No elevated risk for adverse events was observed in patients with a history of TIA.

Limitations

  • Consistency of prior TIA diagnosis may be low.