Masatoshi Koga1, Sohei Yoshimura2, Yasuhiro Hasegawa2, Satoshi Shibuya2, Yasuhiro Ito2, Hideki Matsuoka2, Kazuhiro Takamatsu2, Kazutoshi Nishiyama2, Kenichi Todo2, Kazumi Kimura2, Eisuke Furui2, Tadashi Terasaki2, Yoshiaki Shiokawa2, Kenji Kamiyama2, Shunya Takizawa2, Satoshi Okuda2, Yasushi Okada2, Tomoaki Kameda2, Yoshinari Nagakane2, Yoshiki Yagita2, Kazuomi Kario2, Masayuki Shiozawa2, Shoichiro Sato2, Hiroshi Yamagami2, Shoji Arihiro2, Kazunori Toyoda2. 1. From the Division of Stroke Care Unit (M.K., S.A.), Department of Cerebrovascular Medicine (S.Y., M.S., S. Sato, K. Toyoda), and Department of Neurology (H.Y.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan (Y.H.); Department of Neurology, South Miyagi Medical Center, Ogawara, Japan (S. Shibuya); Department of Neurology, Toyota Memorial Hospital, Toyota, Japan (Y.I.); Department of Cerebrovascular Medicine, NHO Kagoshima Medical Center, Kagoshima, Japan (H.M.); Department of Neurology, Ohta Memorial Hospital, Fukuyama, Japan (K. Takamatsu); Department of Neurology, Kitasato University School of Medicine, Sagamihara, Japan (K.N.); Department of Neurology, Kobe City Medical Center General Hospital, Japan (K. Todo); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (K. Kimura, Y.Y.); Department of Stroke Neurology, Kohnan Hospital, Sendai, Japan (E.F.); Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan (T.T.); Departments of Neurosurgery and Stroke Center, Kyorin University School of Medicine, Mitaka, Japan (Y.S.); Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan (K. Kamiyama); Department of Neurology, Tokai University School of Medicine, Isehara, Japan (S.T.); Department of Neurology, NHO Nagoya Medical Center, Nagoya, Japan (S.O.); Department of Neurology and Cerebrovascular Medicine, NHO Kyushu Medical Center, Fukuoka, Japan (Y.O.); Division of Neurology (T.K.) and Division of Cardiovascular Medicine (K. Kario), Jichi Medical University School of Medicine, Shimotsuke, Japan; and Department of Neurology, Kyoto Second Red Cross Hospital, Kyoto, Japan (Y.N.). koga@ncvc.go.jp. 2. From the Division of Stroke Care Unit (M.K., S.A.), Department of Cerebrovascular Medicine (S.Y., M.S., S. Sato, K. Toyoda), and Department of Neurology (H.Y.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan (Y.H.); Department of Neurology, South Miyagi Medical Center, Ogawara, Japan (S. Shibuya); Department of Neurology, Toyota Memorial Hospital, Toyota, Japan (Y.I.); Department of Cerebrovascular Medicine, NHO Kagoshima Medical Center, Kagoshima, Japan (H.M.); Department of Neurology, Ohta Memorial Hospital, Fukuyama, Japan (K. Takamatsu); Department of Neurology, Kitasato University School of Medicine, Sagamihara, Japan (K.N.); Department of Neurology, Kobe City Medical Center General Hospital, Japan (K. Todo); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (K. Kimura, Y.Y.); Department of Stroke Neurology, Kohnan Hospital, Sendai, Japan (E.F.); Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan (T.T.); Departments of Neurosurgery and Stroke Center, Kyorin University School of Medicine, Mitaka, Japan (Y.S.); Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan (K. Kamiyama); Department of Neurology, Tokai University School of Medicine, Isehara, Japan (S.T.); Department of Neurology, NHO Nagoya Medical Center, Nagoya, Japan (S.O.); Department of Neurology and Cerebrovascular Medicine, NHO Kyushu Medical Center, Fukuoka, Japan (Y.O.); Division of Neurology (T.K.) and Division of Cardiovascular Medicine (K. Kario), Jichi Medical University School of Medicine, Shimotsuke, Japan; and Department of Neurology, Kyoto Second Red Cross Hospital, Kyoto, Japan (Y.N.).
Abstract
BACKGROUND AND PURPOSE: The discrimination between paroxysmal and sustained (persistent or permanent) atrial fibrillation (AF) has not been considered in the approach to secondary stroke prevention. We aimed to assess the differences in clinical outcomes between mostly anticoagulated patients with sustained and paroxysmal AF who had previous ischemic stroke or transient ischemic attack. METHODS: Using data from 1192 nonvalvular AF patients with acute ischemic stroke or transient ischemic attack who were registered in the SAMURAI-NVAF study (Stroke Management With Urgent Risk-Factor Assessment and Improvement-Nonvalvular AF; a prospective, multicenter, observational study), we divided patients into those with paroxysmal AF and those with sustained AF. We compared clinical outcomes between the 2 groups. RESULTS: The median follow-up period was 1.8 (interquartile range, 0.93-2.0) years. Of the 1192 patients, 758 (336 women; 77.9±9.9 years old) and 434 (191 women; 77.3±10.0 years old) were assigned to the sustained AF group and paroxysmal AF groups, respectively. After adjusting for sex, age, previous anticoagulation, and initial National Institutes of Health Stroke Scale score, sustained AF was negatively associated with 3-month independence (multivariable-adjusted odds ratio, 0.61; 95% confidence interval, 0.43-0.87; P=0.006). The annual rate of stroke or systemic embolism was 8.3 and 4.6 per 100 person-years, respectively (multivariable-adjusted hazard ratio, 1.95; 95% confidence interval, 1.26-3.14) and that of major bleeding events was 3.4 and 3.1, respectively (hazard ratio, 1.13; 95% confidence interval, 0.63-2.08). CONCLUSIONS: Among patients with previous ischemic stroke or transient ischemic attack, those with sustained AF had a higher risk of stroke or systemic embolism compared with those with paroxysmal AF. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01581502.
BACKGROUND AND PURPOSE: The discrimination between paroxysmal and sustained (persistent or permanent) atrial fibrillation (AF) has not been considered in the approach to secondary stroke prevention. We aimed to assess the differences in clinical outcomes between mostly anticoagulated patients with sustained and paroxysmal AF who had previous ischemic stroke or transient ischemic attack. METHODS: Using data from 1192 nonvalvular AFpatients with acute ischemic stroke or transient ischemic attack who were registered in the SAMURAI-NVAF study (Stroke Management With Urgent Risk-Factor Assessment and Improvement-Nonvalvular AF; a prospective, multicenter, observational study), we divided patients into those with paroxysmal AF and those with sustained AF. We compared clinical outcomes between the 2 groups. RESULTS: The median follow-up period was 1.8 (interquartile range, 0.93-2.0) years. Of the 1192 patients, 758 (336 women; 77.9±9.9 years old) and 434 (191 women; 77.3±10.0 years old) were assigned to the sustained AF group and paroxysmal AF groups, respectively. After adjusting for sex, age, previous anticoagulation, and initial National Institutes of Health Stroke Scale score, sustained AF was negatively associated with 3-month independence (multivariable-adjusted odds ratio, 0.61; 95% confidence interval, 0.43-0.87; P=0.006). The annual rate of stroke or systemic embolism was 8.3 and 4.6 per 100 person-years, respectively (multivariable-adjusted hazard ratio, 1.95; 95% confidence interval, 1.26-3.14) and that of major bleeding events was 3.4 and 3.1, respectively (hazard ratio, 1.13; 95% confidence interval, 0.63-2.08). CONCLUSIONS: Among patients with previous ischemic stroke or transient ischemic attack, those with sustained AF had a higher risk of stroke or systemic embolism compared with those with paroxysmal AF. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01581502.
Authors: Jin Man Jung; Yong Hyun Kim; Sungwook Yu; Kyungmi O; Chi Kyung Kim; Tae Jin Song; Yong Jae Kim; Bum Joon Kim; Sung Hyuk Heo; Kwang Yeol Park; Jeong Min Kim; Jong Ho Park; Jay Chol Choi; Man Seok Park; Joon Tae Kim; Kang Ho Choi; Yang Ha Hwang; Jong Won Chung; Oh Young Bang; Gyeong Moon Kim; Woo Keun Seo Journal: J Clin Neurol Date: 2019-10 Impact factor: 3.077
Authors: Dan Atar; Eivind Berge; Jean-Yves Le Heuzey; Saverio Virdone; A John Camm; Jan Steffel; Harry Gibbs; Samuel Z Goldhaber; Shinya Goto; Gloria Kayani; Frank Misselwitz; Janina Stepinska; Alexander G G Turpie; Jean-Pierre Bassand; Ajay K Kakkar Journal: Europace Date: 2020-02-01 Impact factor: 5.214