Werner Hacke1, Jean-Pierre Bassand2, Saverio Virdone3, A John Camm4, David A Fitzmaurice5, Keith Aa Fox6, Samuel Z Goldhaber7, Shinya Goto8, Sylvia Haas9, Gloria Kayani3, Lorenzo G Mantovani10, Frank Misselwitz11, Karen S Pieper3, Alexander Gg Turpie12, Martin van Eickels11, Freek Wa Verheugt13, Ajay K Kakkar3,14. 1. Department of Neurology, University of Heidelberg, Heidelberg, Germany. 2. Department of Cardiology, University of Besançon, Besançon, France. 3. Department of Clinical Research, Thrombosis Research Institute, London, UK. 4. Molecular and Clinical Sciences Institute, St. George's University of London, London, UK. 5. Warwick Medical School, University of Warwick, Coventry, UK. 6. Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK. 7. Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, USA. 8. Department of Medicine (Cardiology), Tokai University School of Medicine, Kanagawa, Japan. 9. Formerly Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. 10. Center for Public Health Research, University of Milan Bicocca, and IRCCS Multimedica Milan, Italy. 11. Therapeutic areas Thrombosis & Hematology, Bayer AG Pharmaceuticals, Berlin, Germany. 12. Department of Medicine, McMaster University, Hamilton, Canada. 13. Department of Cardiology, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands. 14. Department of Surgery, University College London, London, UK.
Abstract
BACKGROUND: It is not always possible to verify whether a patient complaining of symptoms consistent with transient ischemic attack has had an actual cerebrovascular event. RESEARCH QUESTION: To characterize the risk of cardiovascular events associated with a history of stroke/transient ischemic attack in patients with atrial fibrillation. STUDY DESIGN AND METHODS: This study investigated the clinical characteristics and outcomes of patients with a history of stroke/transient ischemic attack among 52,014 patients enrolled prospectively in GARFIELD-AF registry. The diagnosis of stroke or transient ischemic attack was not protocol defined but based on physicians' assessment. Patients' one-year risk of death, stroke/systemic embolism, and major bleeding was assessed by multivariable Cox regression. RESULTS: At enrollment, 5617 (10.9%) patients were reported to have a history of stroke or transient ischemic attack. Patients with stroke or transient ischemic attack were older and had a greater burden of diabetes, moderate-to-severe kidney disease, and atherothrombosis and higher median CHA2DS2-VASc and HAS-BLED scores than those without history of stroke or transient ischemic attack. After adjustment, prior stroke/transient ischemic attack was associated with significantly higher risk for all-cause mortality (hazard ratio (HR), 1.26; 95% confidence interval (CI), 1.12-1.42), cardiovascular death (HR, 1.22; 95% CI, 1.01-1.48), non-cardiovascular death (HR, 1.39; 95% CI, 1.15-1.68), and stroke/systemic embolism (HR, 2.17; 95% CI, 1.80-2.63) than patients without history of stroke/transient ischemic attack. In patients with a prior stroke alone higher risk was observed for all-cause mortality (HR, 1.29; 95% CI, 1.11-1.50), non-cardiovascular death (HR, 1.39; 95% CI, 1.10-1.77), and stroke/systemic embolism (HR, 2.29; 95% CI, 1.83-2.86). No significantly elevated risk of adverse events was seen for patients with history of transient ischemic attack alone. INTERPRETATION: A history of prior stroke or transient ischemic attack is a strong independent risk factor for mortality and stroke/systemic embolism. This excess risk is mainly attributed to a history of stroke (with or without transient ischemic attack), whereas history of transient ischemic attack is a weaker predictor. Clinical trial registration: NCT01090362.
BACKGROUND: It is not always possible to verify whether a patient complaining of symptoms consistent with transient ischemic attack has had an actual cerebrovascular event. RESEARCH QUESTION: To characterize the risk of cardiovascular events associated with a history of stroke/transient ischemic attack in patients with atrial fibrillation. STUDY DESIGN AND METHODS: This study investigated the clinical characteristics and outcomes of patients with a history of stroke/transient ischemic attack among 52,014 patients enrolled prospectively in GARFIELD-AF registry. The diagnosis of stroke or transient ischemic attack was not protocol defined but based on physicians' assessment. Patients' one-year risk of death, stroke/systemic embolism, and major bleeding was assessed by multivariable Cox regression. RESULTS: At enrollment, 5617 (10.9%) patients were reported to have a history of stroke or transient ischemic attack. Patients with stroke or transient ischemic attack were older and had a greater burden of diabetes, moderate-to-severe kidney disease, and atherothrombosis and higher median CHA2DS2-VASc and HAS-BLED scores than those without history of stroke or transient ischemic attack. After adjustment, prior stroke/transient ischemic attack was associated with significantly higher risk for all-cause mortality (hazard ratio (HR), 1.26; 95% confidence interval (CI), 1.12-1.42), cardiovascular death (HR, 1.22; 95% CI, 1.01-1.48), non-cardiovascular death (HR, 1.39; 95% CI, 1.15-1.68), and stroke/systemic embolism (HR, 2.17; 95% CI, 1.80-2.63) than patients without history of stroke/transient ischemic attack. In patients with a prior stroke alone higher risk was observed for all-cause mortality (HR, 1.29; 95% CI, 1.11-1.50), non-cardiovascular death (HR, 1.39; 95% CI, 1.10-1.77), and stroke/systemic embolism (HR, 2.29; 95% CI, 1.83-2.86). No significantly elevated risk of adverse events was seen for patients with history of transient ischemic attack alone. INTERPRETATION: A history of prior stroke or transient ischemic attack is a strong independent risk factor for mortality and stroke/systemic embolism. This excess risk is mainly attributed to a history of stroke (with or without transient ischemic attack), whereas history of transient ischemic attack is a weaker predictor. Clinical trial registration: NCT01090362.
Entities:
Keywords:
Atrial fibrillation; bleeding; history of stroke/transient ischemic attack; mortality; stroke
Authors: Sean Tan; Clare Elisabeth Si Min Ho; Yao Neng Teo; Yao Hao Teo; Mark Yan-Yee Chan; Chi-Hang Lee; Lauren Kay Mance Evangelista; Weiqin Lin; Yao-Feng Chong; Tiong-Cheng Yeo; Vijay Kumar Sharma; Raymond C C Wong; Benjamin Y Q Tan; Leonard L L Yeo; Ping Chai; Ching-Hui Sia Journal: Front Cardiovasc Med Date: 2022-09-15