Maurizio Paciaroni1, Filippo Angelini1, Giancarlo Agnelli1, Georgios Tsivgoulis2,3, Karen L Furie4, Prasanna Tadi4, Cecilia Becattini1, Nicola Falocci1, Marialuisa Zedde5, Azmil H Abdul-Rahim6, Kennedy R Lees6, Andrea Alberti1, Michele Venti1, Monica Acciarresi1, Riccardo Altavilla1, Cataldo D'Amore1, Maria G Mosconi1, Ludovica A Cimini1, Paolo Bovi7, Monica Carletti7, Alberto Rigatelli7, Manuel Cappellari7, Jukka Putaala8, Liisa Tomppo8, Turgut Tatlisumak8,9, Fabio Bandini10, Simona Marcheselli11, Alessandro Pezzini12, Loris Poli12, Alessandro Padovani12, Luca Masotti13, Vieri Vannucchi13, Sung-Il Sohn14, Gianni Lorenzini15, Rossana Tassi16, Francesca Guideri16, Maurizio Acampa16, Giuseppe Martini16, George Ntaios17, Efstathia Karagkiozi17, George Athanasakis17, Kostantinos Makaritsis17, Kostantinos Vadikolias18, Chrysoula Liantinioti2, Maria Chondrogianni2, Nicola Mumoli19, Domenico Consoli20, Franco Galati20, Simona Sacco21, Antonio Carolei21, Cindy Tiseo21, Francesco Corea22, Walter Ageno23, Marta Bellesini23, Giorgio Silvestrelli24, Alfonso Ciccone24, Umberto Scoditti25, Licia Denti26, Michelangelo Mancuso27, Miriam Maccarrone27, Giovanni Orlandi27,28, Nicola Giannini27, Gino Gialdini27, Tiziana Tassinari29, Maria Luisa De Lodovici30, Giorgio Bono30, Christina Rueckert31, Antonio Baldi32, Danilo Toni33, Federica Letteri33, Martina Giuntini28, Enrico M Lotti34, Yuriy Flomin35, Alessio Pieroni33, Odysseas Kargiotis36, Theodore Karapanayiotides37, Serena Monaco38, Mario M Baronello38, Laszló Csiba39, Lilla Szabó39, Alberto Chiti40,27, Elisa Giorli40, Massimo Del Sette40,41, Davide Imberti42, Dorjan Zabzuni42, Boris Doronin43, Vera Volodina43, Patrik Michel Pd-Mer44, Peter Vanacker45, Kristian Barlinn46, Lars P Pallesen46, Jessica Kepplinger46, Dirk Deleu47, Gayane Melikyan47, Faisal Ibrahim47, Naveed Akhtar47, Vanessa Gourbali48, Shadi Yaghi4, Valeria Caso1. 1. Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy. 2. Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National & Kapodistrian University of Athens, Athens, Greece. 3. Department of Neurology, University of Tennessee Health Sciences Center, Memphis, TN, USA. 4. Division of Stroke and Cerebrovascular Diseases, Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI, USA. 5. Neurology Unit, Stroke Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy. 6. Medical School and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK. 7. SSO Stroke Unit, UO Neurologia, DAI di Neuroscienze, AOUI, Verona, Italy. 8. Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland. 9. Department of Clinical Neurosciences, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden. 10. Department of Neurology, Ospedale San Paolo, Savona, Italy. 11. Neurologia d'urgenza e Stroke Unit, Istituto Clinico Humanitas, Rozzano, Milano, Italy. 12. Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy. 13. Internal Medicine, Santa Maria Nuova Hospital, Firenze, Italy. 14. Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea. 15. SC di Medicina e Chirurgia d'Accettazione e d'Urgenza degli ospedali di Pontedera e Volterra, Pontedera e Volterra, Italy. 16. Stroke Unit, AOU Senese, Siena, Italy. 17. Department of Medicine, University of Thessaly, Larissa, Greece. 18. Department of Neurology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece. 19. Department of Internal Medicine, Ospedale Civile di Livorno, Livorno, Italy. 20. Stroke Unit, Jazzolino Hospital, Vibo Valentia, Italy. 21. Department of Neurology, University of L'Aquila, Avezzano Hospital, Avezzano, Italy. 22. UO Gravi Cerebrolesioni, San Giovanni Battista Hospital, Foligno, Italy. 23. Department of Internal Medicine, Insubria University, Varese, Italy. 24. SC di Neurologia e S.S. di Stroke Unit, ASST di Mantova, Mantova, Italy. 25. Stroke Unit, Neuroscience Department, University of Parma, Parma, Italy. 26. Stroke Unit, Dipartimento Geriatrico Riabilitativo, University of Parma, Parma, Italy. 27. Clinica Neurologica, Azienda Ospedaliero-Universitaria, Pisa, Italy. 28. Neurologia, Ospedale Apuano, Massa Carrara, Italy. 29. Stroke Unit, Department of Neurology, Santa Corona Hospital, Pietra Ligure, Savona, Italy. 30. Stroke Unit, Neurology, Insubria University, Varese, Italy. 31. Abteilung für Neurologie, Oberschwabenklinik gGmbH, Ravensburg, Germany. 32. Stroke Unit, Ospedale di Portogruaro, Portogruaro, Venice, Italy. 33. Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy. 34. UO Neurologia Presidio Ospedaliero di Ravenna Azienda USL della Romagna, Ravenna, Italy. 35. Stroke and Neurorehabilitation Unit MC 'Universal Clinic 'Oberig', Kyiv, Ukraine. 36. Stroke Unit, Metropolitan Hospital, Piraeus, Greece. 37. 2nd Department of Neurology, AHEPA University Hospital, Thessaloniki, Greece. 38. Stroke Unit, Ospedale Civico, Palermo, Italy. 39. Stroke Unit, University of Debrecen, Debrecen, Hungary. 40. Stroke Unit, Department of Neurology, Sant'Andrea Hospital, La Spezia, Italy. 41. Divisione di Neurologia, Ospedale Galliera, Genoa, Italy. 42. Department of Internal Medicine, Ospedale Civile di Piacenza, Italy. 43. Municipal Budgetary Healthcare Institution of Novosibirsk, City Clinical Hospital n° 1, Novosibirsk State Medical University, Novosibirsk, Russia. 44. Centre Cérébrovasculaire, Service de Neurologie, Département des Neurosciences Cliniques Centre Hopitalier Universitaire Vaudois, Lausanne, Switzerland. 45. Department of Neurology, Born Bunge Institute, Antwerp University Hospital, Antwerp, Belgium. 46. Department of Neurology, Dresden University Stroke Center, Dresden, Germany. 47. Neurology, Hamad Medical Corporation, Doha, Qatar. 48. Department of Neurology, Evangelismos Hospital, Athens, Greece.
Abstract
BACKGROUND: The relationship between different patterns of atrial fibrillation and early recurrence after an acute ischaemic stroke is unclear. PURPOSE: In a prospective cohort study, we evaluated the rates of early ischaemic recurrence after an acute ischaemic stroke in patients with paroxysmal atrial fibrillation or sustained atrial fibrillation which included persistent and permanent atrial fibrillation. METHODS: In patients with acute ischaemic stroke, atrial fibrillation was categorised as paroxysmal atrial fibrillation or sustained atrial fibrillation. Ischaemic recurrences were the composite of ischaemic stroke, transient ischaemic attack and symptomatic systemic embolism occurring within 90 days from acute index stroke. RESULTS: A total of 2150 patients (1155 females, 53.7%) were enrolled: 930 (43.3%) had paroxysmal atrial fibrillation and 1220 (56.7%) sustained atrial fibrillation. During the 90-day follow-up, 111 ischaemic recurrences were observed in 107 patients: 31 in patients with paroxysmal atrial fibrillation (3.3%) and 76 with sustained atrial fibrillation (6.2%) (hazard ratio (HR) 1.86 (95% CI 1.24-2.81)). Patients with sustained atrial fibrillation were on average older, more likely to have diabetes mellitus, hypertension, history of stroke/ transient ischaemic attack, congestive heart failure, atrial enlargement, high baseline NIHSS-score and implanted pacemaker. After adjustment by Cox proportional hazard model, sustained atrial fibrillation was not associated with early ischaemic recurrences (adjusted HR 1.23 (95% CI 0.74-2.04)). CONCLUSIONS: After acute ischaemic stroke, patients with sustained atrial fibrillation had a higher rate of early ischaemic recurrence than patients with paroxysmal atrial fibrillation. After adjustment for relevant risk factors, sustained atrial fibrillation was not associated with a significantly higher risk of recurrence, thus suggesting that the risk profile associated with atrial fibrillation, rather than its pattern, is determinant for recurrence.
BACKGROUND: The relationship between different patterns of atrial fibrillation and early recurrence after an acute ischaemic stroke is unclear. PURPOSE: In a prospective cohort study, we evaluated the rates of early ischaemic recurrence after an acute ischaemic stroke in patients with paroxysmal atrial fibrillation or sustained atrial fibrillation which included persistent and permanent atrial fibrillation. METHODS: In patients with acute ischaemic stroke, atrial fibrillation was categorised as paroxysmal atrial fibrillation or sustained atrial fibrillation. Ischaemic recurrences were the composite of ischaemic stroke, transient ischaemic attack and symptomatic systemic embolism occurring within 90 days from acute index stroke. RESULTS: A total of 2150 patients (1155 females, 53.7%) were enrolled: 930 (43.3%) had paroxysmal atrial fibrillation and 1220 (56.7%) sustained atrial fibrillation. During the 90-day follow-up, 111 ischaemic recurrences were observed in 107 patients: 31 in patients with paroxysmal atrial fibrillation (3.3%) and 76 with sustained atrial fibrillation (6.2%) (hazard ratio (HR) 1.86 (95% CI 1.24-2.81)). Patients with sustained atrial fibrillation were on average older, more likely to have diabetes mellitus, hypertension, history of stroke/ transient ischaemic attack, congestive heart failure, atrial enlargement, high baseline NIHSS-score and implanted pacemaker. After adjustment by Cox proportional hazard model, sustained atrial fibrillation was not associated with early ischaemic recurrences (adjusted HR 1.23 (95% CI 0.74-2.04)). CONCLUSIONS: After acute ischaemic stroke, patients with sustained atrial fibrillation had a higher rate of early ischaemic recurrence than patients with paroxysmal atrial fibrillation. After adjustment for relevant risk factors, sustained atrial fibrillation was not associated with a significantly higher risk of recurrence, thus suggesting that the risk profile associated with atrial fibrillation, rather than its pattern, is determinant for recurrence.
Authors: Samuel Lévy; A John Camm; Sanjeev Saksena; Etienne Aliot; Gunter Breithardt; Harry J G M Crijns; D Wyn Davies; G Neal Kay; Eric N Prystowsky; Richard Sutton; Albert L Waldo; D George Wyse Journal: J Cardiovasc Electrophysiol Date: 2003-04
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