Early recurrence in paroxysmal versus sustained atrial fibrillation in patients with acute ischaemic stroke-Reference-Cited by-同舟云学术

Early recurrence in paroxysmal versus sustained atrial fibrillation in patients with acute ischaemic stroke

Published:2018-07-25 Issue:1 Volume:4 Page:55-64
ISSN:2396-9873
Container-title:European Stroke Journal
language:en
Short-container-title:European Stroke Journal

Author:

Paciaroni Maurizio¹,Angelini Filippo¹,Agnelli Giancarlo¹,Tsivgoulis Georgios²³,Furie Karen L⁴,Tadi Prasanna⁴,Becattini Cecilia¹,Falocci Nicola¹,Zedde Marialuisa⁵,Abdul-Rahim Azmil H⁶,Lees Kennedy R⁶,Alberti Andrea¹,Venti Michele¹,Acciarresi Monica¹,Altavilla Riccardo¹,D’Amore Cataldo¹,Mosconi Maria G¹,Cimini Ludovica A¹,Bovi Paolo⁷,Carletti Monica⁷,Rigatelli Alberto⁷,Cappellari Manuel⁷,Putaala Jukka⁸,Tomppo Liisa⁸,Tatlisumak Turgut⁸⁹,Bandini Fabio¹⁰,Marcheselli Simona¹¹,Pezzini Alessandro¹²,Poli Loris¹²,Padovani Alessandro¹²,Masotti Luca¹³,Vannucchi Vieri¹³,Sohn Sung-Il¹⁴,Lorenzini Gianni¹⁵,Tassi Rossana¹⁶,Guideri Francesca¹⁶,Acampa Maurizio¹⁶^ORCID,Martini Giuseppe¹⁶,Ntaios George¹⁷,Karagkiozi Efstathia¹⁷,Athanasakis George¹⁷,Makaritsis Kostantinos¹⁷,Vadikolias Kostantinos¹⁸,Liantinioti Chrysoula²,Chondrogianni Maria²,Mumoli Nicola¹⁹,Consoli Domenico²⁰,Galati Franco²⁰,Sacco Simona²¹,Carolei Antonio²¹,Tiseo Cindy²¹,Corea Francesco²²,Ageno Walter²³,Bellesini Marta²³,Silvestrelli Giorgio²⁴,Ciccone Alfonso²⁴,Scoditti Umberto²⁵,Denti Licia²⁶,Mancuso Michelangelo²⁷,Maccarrone Miriam²⁷,Orlandi Giovanni²⁷²⁸,Giannini Nicola²⁷,Gialdini Gino²⁷,Tassinari Tiziana²⁹,Lodovici Maria Luisa De³⁰,Bono Giorgio³⁰,Rueckert Christina³¹,Baldi Antonio³²,Toni Danilo³³,Letteri Federica³³,Giuntini Martina²⁸,Lotti Enrico M³⁴,Flomin Yuriy³⁵,Pieroni Alessio³³,Kargiotis Odysseas³⁶,Karapanayiotides Theodore³⁷,Monaco Serena³⁸,Baronello Mario M³⁸,Csiba Laszló³⁹,Szabó Lilla³⁹,Chiti Alberto²⁷⁴⁰,Giorli Elisa⁴⁰,Sette Massimo Del⁴⁰⁴¹,Imberti Davide⁴²,Zabzuni Dorjan⁴²,Doronin Boris⁴³,Volodina Vera⁴³,Michel Pd-Mer Patrik⁴⁴,Vanacker Peter⁴⁵,Barlinn Kristian⁴⁶,Pallesen Lars P⁴⁶,Kepplinger Jessica⁴⁶,Deleu Dirk⁴⁷,Melikyan Gayane⁴⁷,Ibrahim Faisal⁴⁷,Akhtar Naveed⁴⁷,Gourbali Vanessa⁴⁸,Yaghi Shadi⁴,Caso Valeria¹

Affiliation:

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.

Publisher

SAGE Publications

Subject

Cardiology and Cardiovascular Medicine,Clinical Neurology

Link

http://journals.sagepub.com/doi/pdf/10.1177/2396987318785853

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