Luciano A Sposato1, Joshua O Cerasuolo2, Lauren E Cipriano2, Jiming Fang2, Sebastian Fridman2, Maryse Paquet2, Gustavo Saposnik2. 1. From the Department of Clinical Neurological Sciences, London Health Sciences Centre (L.A.S., S.F.), Department of Anatomy and Cell Biology (L.A.S.), and Department of Epidemiology and Biostatistics (L.A.S., J.O.C., L.E.C.), Schulich School of Medicine and Dentistry, Stroke, Dementia, and Heart Disease Lab (L.A.S., M.P.), and Ivey Business School (L.E.C.), Western University, London; Institute for Clinical Evaluative Sciences (J.F., G.S.), Toronto; Stroke Outcomes & Decision Neuroscience Research Unit (G.S.), Division of Neurology, Department of Medicine, St. Michael's Hospital and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, Institute for Clinical Evaluative Sciences, University of Toronto; and Li Ka Shing Knowledge Institute (G.S.), Toronto, Canada. lsposato@uwo.ca. 2. From the Department of Clinical Neurological Sciences, London Health Sciences Centre (L.A.S., S.F.), Department of Anatomy and Cell Biology (L.A.S.), and Department of Epidemiology and Biostatistics (L.A.S., J.O.C., L.E.C.), Schulich School of Medicine and Dentistry, Stroke, Dementia, and Heart Disease Lab (L.A.S., M.P.), and Ivey Business School (L.E.C.), Western University, London; Institute for Clinical Evaluative Sciences (J.F., G.S.), Toronto; Stroke Outcomes & Decision Neuroscience Research Unit (G.S.), Division of Neurology, Department of Medicine, St. Michael's Hospital and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, Institute for Clinical Evaluative Sciences, University of Toronto; and Li Ka Shing Knowledge Institute (G.S.), Toronto, Canada.
Abstract
OBJECTIVE: To compare the risk of 1-year ischemic stroke recurrence between atrial fibrillation (AF) diagnosed after stroke (AFDAS) and sinus rhythm (SR) and investigate whether underlying heart disease is as frequent in AFDAS as it is in AF known before stroke (KAF). METHODS: In this retrospective cohort study, we included all ischemic stroke patients admitted to institutions participating in the Ontario Stroke Registry from July 1, 2003, to March 31, 2013. Based on heart rhythm assessed during admission, we classified patients as AFDAS, KAF, or SR. We modeled the relationship between heart rhythm groups and 1-year ischemic stroke recurrence by using Cox regression adjusted for multiple covariates (e.g., oral anticoagulants). We compared the prevalence of coronary artery disease, myocardial infarction, and heart failure among the 3 groups. RESULTS: Among 23,376 ischemic stroke patients, 15,885 had SR, 587 AFDAS, and 6,904 KAF. At 1 year, 39 (6.6%) patients with AFDAS, 661 (9.6%) with KAF, and 1,269 (8.0%) with SR had recurrent ischemic strokes (p = 0.0001). AFDAS-related ischemic stroke recurrence adjusted risk was not different from that of SR (hazard ratio 0.90 [95% confidence interval 0.63, 1.30]; p = 0.57). Prevalence of coronary artery disease (18.2% vs 34.7%; p < 0.0001), myocardial infarction (11.6% vs 20.5%; p < 0.0001), and heart failure (5.5% vs 16.8%; p < 0.0001) were lower in AFDAS relative to KAF. CONCLUSIONS: The lack of difference in 1-year ischemic stroke recurrence between AFDAS and SR and the lower prevalence of heart disease in AFDAS compared to KAF suggest that the underlying pathophysiology of AFDAS may differ from that of KAF.
OBJECTIVE: To compare the risk of 1-year ischemic stroke recurrence between atrial fibrillation (AF) diagnosed after stroke (AFDAS) and sinus rhythm (SR) and investigate whether underlying heart disease is as frequent in AFDAS as it is in AF known before stroke (KAF). METHODS: In this retrospective cohort study, we included all ischemic strokepatients admitted to institutions participating in the Ontario Stroke Registry from July 1, 2003, to March 31, 2013. Based on heart rhythm assessed during admission, we classified patients as AFDAS, KAF, or SR. We modeled the relationship between heart rhythm groups and 1-year ischemic stroke recurrence by using Cox regression adjusted for multiple covariates (e.g., oral anticoagulants). We compared the prevalence of coronary artery disease, myocardial infarction, and heart failure among the 3 groups. RESULTS: Among 23,376 ischemic strokepatients, 15,885 had SR, 587 AFDAS, and 6,904 KAF. At 1 year, 39 (6.6%) patients with AFDAS, 661 (9.6%) with KAF, and 1,269 (8.0%) with SR had recurrent ischemic strokes (p = 0.0001). AFDAS-related ischemic stroke recurrence adjusted risk was not different from that of SR (hazard ratio 0.90 [95% confidence interval 0.63, 1.30]; p = 0.57). Prevalence of coronary artery disease (18.2% vs 34.7%; p < 0.0001), myocardial infarction (11.6% vs 20.5%; p < 0.0001), and heart failure (5.5% vs 16.8%; p < 0.0001) were lower in AFDAS relative to KAF. CONCLUSIONS: The lack of difference in 1-year ischemic stroke recurrence between AFDAS and SR and the lower prevalence of heart disease in AFDAS compared to KAF suggest that the underlying pathophysiology of AFDAS may differ from that of KAF.
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