Abstract
Background: Atrial fibrillation (AF) is a common arrhythmia and a major risk factor for stroke.
Aims: To assess whether AF in patients with acute ischaemic stroke is associated with severe stroke and early death.
Materials/methods: Patients with acute ischaemic stroke (15 831) who were registered in the Japan Multicenter Stroke Investigators' Collaboration registry were analysed. The AF group comprised 3335 (21.1%) patients (median age, 75 years) and the non-AF group comprised 12 496 (78.9%) patients (median age, 70 years). The association between AF and severe stroke and early death was investigated by means of multivariate logistic regression analysis.
Results: The admission National Institutes of Health Stroke Scale (NIHSS) score of the AF group was higher than that of the non-AF group (median, 12 v 5; p < 0.0001). Multivariate logistic regression analyses found that female sex, advanced age, AF, and a history of stroke were independent factors associated with severe stroke (NIHSS score, ⩾ 11). The mortality rate within 28 days after admission was 11.3% in the AF group and 3.4% in the non-AF group (p < 0.0001). Multivariate logistic regression analyses identified older age, AF, and NIHSS score at admission as independent factors associated with early death.
Conclusion: AF was a predictive factor for severe stroke and early death in acute ischaemic stroke. Careful cardiac evaluation and appropriate treatment are needed to improve outcome in patients with acute stroke and AF.
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Selected References
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- Adams H. P., Jr, Davis P. H., Leira E. C., Chang K. C., Bendixen B. H., Clarke W. R., Woolson R. F., Hansen M. D. Baseline NIH Stroke Scale score strongly predicts outcome after stroke: A report of the Trial of Org 10172 in Acute Stroke Treatment (TOAST). Neurology. 1999 Jul 13;53(1):126–131. doi: 10.1212/wnl.53.1.126. [DOI] [PubMed] [Google Scholar]
- Allen C. M. Predicting the outcome of acute stroke: a prognostic score. J Neurol Neurosurg Psychiatry. 1984 May;47(5):475–480. doi: 10.1136/jnnp.47.5.475. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Anderson C. S., Jamrozik K. D., Broadhurst R. J., Stewart-Wynne E. G. Predicting survival for 1 year among different subtypes of stroke. Results from the Perth Community Stroke Study. Stroke. 1994 Oct;25(10):1935–1944. doi: 10.1161/01.str.25.10.1935. [DOI] [PubMed] [Google Scholar]
- Bogousslavsky J., Van Melle G., Regli F. The Lausanne Stroke Registry: analysis of 1,000 consecutive patients with first stroke. Stroke. 1988 Sep;19(9):1083–1092. doi: 10.1161/01.str.19.9.1083. [DOI] [PubMed] [Google Scholar]
- Britton M., Gustafsson C. Non-rheumatic atrial fibrillation as a risk factor for stroke. Stroke. 1985 Mar-Apr;16(2):182–188. doi: 10.1161/01.str.16.2.182. [DOI] [PubMed] [Google Scholar]
- Broderick J. P., Phillips S. J., O'Fallon W. M., Frye R. L., Whisnant J. P. Relationship of cardiac disease to stroke occurrence, recurrence, and mortality. Stroke. 1992 Sep;23(9):1250–1256. doi: 10.1161/01.str.23.9.1250. [DOI] [PubMed] [Google Scholar]
- Candelise L., Pinardi G., Morabito A. Mortality in acute stroke with atrial fibrillation. The Italian Acute Stroke Study Group. Stroke. 1991 Feb;22(2):169–174. doi: 10.1161/01.str.22.2.169. [DOI] [PubMed] [Google Scholar]
- Censori B., Camerlingo M., Casto L., Ferraro B., Gazzaniga G. C., Cesana B., Mamoli A. Prognostic factors in first-ever stroke in the carotid artery territory seen within 6 hours after onset. Stroke. 1993 Apr;24(4):532–535. doi: 10.1161/01.str.24.4.532. [DOI] [PubMed] [Google Scholar]
- Chen Z. M., Sandercock P., Pan H. C., Counsell C., Collins R., Liu L. S., Xie J. X., Warlow C., Peto R. Indications for early aspirin use in acute ischemic stroke : A combined analysis of 40 000 randomized patients from the chinese acute stroke trial and the international stroke trial. On behalf of the CAST and IST collaborative groups. Stroke. 2000 Jun;31(6):1240–1249. doi: 10.1161/01.str.31.6.1240. [DOI] [PubMed] [Google Scholar]
- Feinberg W. M., Blackshear J. L., Laupacis A., Kronmal R., Hart R. G. Prevalence, age distribution, and gender of patients with atrial fibrillation. Analysis and implications. Arch Intern Med. 1995 Mar 13;155(5):469–473. [PubMed] [Google Scholar]
- Friedman P. J. Atrial fibrillation after stroke in the elderly. Stroke. 1991 Feb;22(2):209–214. doi: 10.1161/01.str.22.2.209. [DOI] [PubMed] [Google Scholar]
- Gustafsson C., Britton M. Pathogenetic mechanism of stroke in non-valvular atrial fibrillation: follow-up of stroke patients with and without atrial fibrillation. J Intern Med. 1991 Jul;230(1):11–16. doi: 10.1111/j.1365-2796.1991.tb00400.x. [DOI] [PubMed] [Google Scholar]
- Heinsius T., Bogousslavsky J., Van Melle G. Large infarcts in the middle cerebral artery territory. Etiology and outcome patterns. Neurology. 1998 Feb;50(2):341–350. doi: 10.1212/wnl.50.2.341. [DOI] [PubMed] [Google Scholar]
- Jørgensen H. S., Nakayama H., Reith J., Raaschou H. O., Olsen T. S. Acute stroke with atrial fibrillation. The Copenhagen Stroke Study. Stroke. 1996 Oct;27(10):1765–1769. doi: 10.1161/01.str.27.10.1765. [DOI] [PubMed] [Google Scholar]
- Kaarisalo M. M., Immonen-Räihä P., Marttila R. J., Salomaa V., Kaarsalo E., Salmi K., Sarti C., Sivenius J., Torppa J., Tuomilehto J. Atrial fibrillation and stroke. Mortality and causes of death after the first acute ischemic stroke. Stroke. 1997 Feb;28(2):311–315. doi: 10.1161/01.str.28.2.311. [DOI] [PubMed] [Google Scholar]
- Kannel W. B., Abbott R. D., Savage D. D., McNamara P. M. Epidemiologic features of chronic atrial fibrillation: the Framingham study. N Engl J Med. 1982 Apr 29;306(17):1018–1022. doi: 10.1056/NEJM198204293061703. [DOI] [PubMed] [Google Scholar]
- Kimura Kazumi, Kazui Seiji, Minematsu Kazuo, Yamaguchi Takenori, Japan Multicenter Stroke Investigator's Collaboration Analysis of 16,922 patients with acute ischemic stroke and transient ischemic attack in Japan. A hospital-based prospective registration study. Cerebrovasc Dis. 2004 Jun 1;18(1):47–56. doi: 10.1159/000078749. [DOI] [PubMed] [Google Scholar]
- Kimura Kazumi, Kazui Seiji, Minematsu Kazuo, Yamaguchi Takenori, Japan Multicenter Stroke Investigators' Collaboration (J-MUSIC) Hospital-based prospective registration of acute ischemic stroke and transient ischemic attack in Japan. J Stroke Cerebrovasc Dis. 2004 JanâFeb;13(1):1–11. doi: 10.1016/j.jstrokecerebrovasdis.2003.11.025. [DOI] [PubMed] [Google Scholar]
- Lavy S., Stern S., Melamed E., Cooper G., Keren A., Levy P. Effect of chronic atrial fibrillation on regional cerebral blood flow. Stroke. 1980 Jan-Feb;11(1):35–38. doi: 10.1161/01.str.11.1.35. [DOI] [PubMed] [Google Scholar]
- Lin H. J., Wolf P. A., Kelly-Hayes M., Beiser A. S., Kase C. S., Benjamin E. J., D'Agostino R. B. Stroke severity in atrial fibrillation. The Framingham Study. Stroke. 1996 Oct;27(10):1760–1764. doi: 10.1161/01.str.27.10.1760. [DOI] [PubMed] [Google Scholar]
- Lowe G. D., Jaap A. J., Forbes C. D. Relation of atrial fibrillation and high haematocrit to mortality in acute stroke. Lancet. 1983 Apr 9;1(8328):784–786. doi: 10.1016/s0140-6736(83)91848-2. [DOI] [PubMed] [Google Scholar]
- Moroney J. T., Bagiella E., Paik M. C., Sacco R. L., Desmond D. W. Risk factors for early recurrence after ischemic stroke: the role of stroke syndrome and subtype. Stroke. 1998 Oct;29(10):2118–2124. doi: 10.1161/01.str.29.10.2118. [DOI] [PubMed] [Google Scholar]
- Petersen P. Thromboembolic complications in atrial fibrillation. Stroke. 1990 Jan;21(1):4–13. doi: 10.1161/01.str.21.1.4. [DOI] [PubMed] [Google Scholar]
- Sage J. I., Van Uitert R. L. Risk of recurrent stroke in patients with atrial fibrillation and non-valvular heart disease. Stroke. 1983 Jul-Aug;14(4):537–540. doi: 10.1161/01.str.14.4.537. [DOI] [PubMed] [Google Scholar]
- Sandercock P., Bamford J., Dennis M., Burn J., Slattery J., Jones L., Boonyakarnkul S., Warlow C. Atrial fibrillation and stroke: prevalence in different types of stroke and influence on early and long term prognosis (Oxfordshire community stroke project) BMJ. 1992 Dec 12;305(6867):1460–1465. doi: 10.1136/bmj.305.6867.1460. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Saxena R., Lewis S., Berge E., Sandercock P. A., Koudstaal P. J. Risk of early death and recurrent stroke and effect of heparin in 3169 patients with acute ischemic stroke and atrial fibrillation in the International Stroke Trial. Stroke. 2001 Oct;32(10):2333–2337. doi: 10.1161/hs1001.097093. [DOI] [PubMed] [Google Scholar]
- Tomita F., Kohya T., Sakurai M., Kaji T., Yokoshiki H., Sato M., Sasaki K., Itoh Y., Konno M., Kitabatake A. Prevalence and clinical characteristics of patients with atrial fibrillation: analysis of 20,000 cases in Japan. Jpn Circ J. 2000 Sep;64(9):653–658. doi: 10.1253/jcj.64.653. [DOI] [PubMed] [Google Scholar]
- Wolf P. A., Abbott R. D., Kannel W. B. Atrial fibrillation: a major contributor to stroke in the elderly. The Framingham Study. Arch Intern Med. 1987 Sep;147(9):1561–1564. [PubMed] [Google Scholar]
- Wolf P. A., Dawber T. R., Thomas H. E., Jr, Kannel W. B. Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: the Framingham study. Neurology. 1978 Oct;28(10):973–977. doi: 10.1212/wnl.28.10.973. [DOI] [PubMed] [Google Scholar]
- Wolf P. A., Kannel W. B., McGee D. L., Meeks S. L., Bharucha N. E., McNamara P. M. Duration of atrial fibrillation and imminence of stroke: the Framingham study. Stroke. 1983 Sep-Oct;14(5):664–667. doi: 10.1161/01.str.14.5.664. [DOI] [PubMed] [Google Scholar]
- van Swieten J. C., Koudstaal P. J., Visser M. C., Schouten H. J., van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988 May;19(5):604–607. doi: 10.1161/01.str.19.5.604. [DOI] [PubMed] [Google Scholar]