Stroke: early recurrence in patients with paroxysmal vs sustained atrial fibrillation

Takeaway

• Among patients with acute ischaemic stroke, the rate of early ischaemic recurrence was higher in patients with sustained atrial fibrillation (SAF) vs those with paroxysmal atrial fibrillation (PAF).
• However, after adjustment for risk factors for early ischaemic recurrence, SAF did not demonstrate a significant association with a higher risk of recurrence.

Why this matters

• Findings suggest that the patient’s risk profile should be given greater relevance and atrial fibrillation pattern should not influence the decision in terms of timing of initiating anti-coagulation treatment after an acute ischaemic stroke.

Study design

• Prospective cohort study of 2150 patients with an acute ischaemic stroke (1155 females, 53.7%) conducted between 2012-2014.
• Ischaemic recurrences occurring with 90 days from acute index stroke were evaluated in patients with PAF vs SAF.
• Funding: None.

Key results

• Among 2150 patients, 930 (43.3%) patients had PAF, while 1220 (56.7%) had SAF.
• During the 90-day follow-up, 111 ischaemic recurrences were recorded in 107 patients (31 in patients with PAF and 76 with SAF).
• Patients with SAF vs PAF were older (77.7±9.5 years vs 74.5±9.8 years; P<.0001) and more likely to have:
  • diabetes mellitus: 24.7% vs 19.5%; P=.004.
  • hypertension: 80.2% vs 76.2%; P=.026.
  • stroke/transient ischaemic attack: 29.3% vs 22.7%; P=.001.
  • congestive heart failure: 23.0% vs 9.6%; P<.0001.
  • pacemaker: 9.1% vs 4.2%; P<.0001.
• 812 (87.3%) patients with PAF and 976 (80.0%) patients with SAF received oral anticoagulants.
• After adjustment, SAF did not result as a risk for ischaemic recurrence when compared with PAF (HR, 1.23; 95% CI, 0.74-2.04; P=.418).

Limitations

• Presence of confounders.