Recurrent vascular events and mortality outcomes in patients with known atrial fibrillation, compared to atrial fibrillation detected early after stroke.

IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY European Stroke Journal Pub Date : 2024-08-21 DOI:10.1177/23969873241272631
Isuru Induruwa, Shiv Bhakta, Rahul Herlekar, Akangsha Sur Roy, Saur Hajiev, Elizabeth A Warburton, Kayvan Khadjooi, John J McCabe
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Abstract

Introduction: Atrial fibrillation (AF) detected after stroke (AFDAS) may represent a distinct clinical entity to that of known AF (KAF). However, there is limited long-term outcome data available for patients with AFDAS. More information regarding prognosis in AFDAS is required to inform future trial design in these patients.

Patients and methods: We used data (2015-2019) from a national prospective stroke registry of consecutive patients with acute ischaemic stroke and AF. AFDAS was defined as a new diagnosis of AF after stroke detected on electrocardiograph or cardiac monitoring. The co-primary endpoints were: (1) all-cause mortality; (2) recurrent major adverse cardiovascular events (MACE) at 3 years. Secondary endpoints were: (1) recurrent stroke; (2) functional outcome at discharge; (3) presence of co-existing stroke mechanisms.

Results: 583 patients were included. After a median follow-up of 2.65 years (cumulative 1064 person-years) 309 patients died and 23 had recurrent MACE. Compared with AFDAS, KAF was associated with a higher risk of all-cause mortality (adjusted Hazard Ratio (aHR) 1.56, 95% CI 1.12-2.18), a higher prevalence of co-existing stroke mechanisms (adjusted odds ratio (aOR) 2.28, 95% CI 1.14-4.59), but not poor functional outcome (aOR 1.61, 95% CI 0.98-2.64). A trend towards a higher risk of MACE was observed in patients with KAF, but this was limited by statistical power (aHR 2.90, 95% CI 0.67-12.51). All 14 recurrent strokes occurred in the KAF group (Log-rank p = 0.03).

Discussion and conclusion: These data provide further evidence that AFDAS differs to KAF with respect to risk of recurrent stroke, MACE, and all-cause mortality.

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与中风后早期发现的心房颤动相比,已知心房颤动患者的复发性血管事件和死亡率结果。
导言:卒中后发现的心房颤动(AFDAS)与已知的心房颤动(KAF)可能是不同的临床实体。然而,目前针对 AFDAS 患者的长期预后数据非常有限。需要更多有关 AFDAS 预后的信息,以便为这些患者未来的试验设计提供参考:我们使用了来自全国性前瞻性卒中登记处的数据(2015-2019 年),登记对象为急性缺血性卒中合并房颤的连续患者。AFDAS的定义是心电图或心脏监测发现卒中后新诊断的房颤。共同主要终点为(1) 全因死亡率;(2) 3 年内复发的主要不良心血管事件 (MACE)。次要终点为(1) 复发中风;(2) 出院时的功能预后;(3) 是否同时存在中风机制:结果:共纳入 583 名患者。中位随访 2.65 年(累计 1064 人年)后,309 名患者死亡,23 名患者复发 MACE。与 AFDAS 相比,KAF 与较高的全因死亡风险(调整后危险比 (aHR) 1.56,95% CI 1.12-2.18)、较高的并存卒中机制发生率(调整后几率比 (aOR) 2.28,95% CI 1.14-4.59)相关,但与较差的功能预后无关(aOR 1.61,95% CI 0.98-2.64)。在 KAF 患者中观察到 MACE 风险较高的趋势,但这受到统计能力的限制(aHR 2.90,95% CI 0.67-12.51)。所有 14 例复发性脑卒中均发生在 KAF 组(Log-rank p = 0.03):这些数据进一步证明,在复发性卒中、MACE 和全因死亡率风险方面,AFDAS 与 KAF 存在差异。
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来源期刊
CiteScore
7.50
自引率
6.60%
发文量
102
期刊介绍: Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.
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