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. 2006 Dec 5;27(1):40–46. doi: 10.1002/clc.4960270111

Mortality and rate of stroke or embolism in atrial fibrillation during long‐term follow‐up in the embolism in left atrial thrombi (ELAT) study

Claudia Stöllberger 1,✉, Pavel Chnupa 2, Christine Abzieher 1, Thomas Länger 3, Josef Finsterer 3, Igor Klem 1, Elisabeth Hartl 1, Cornelius Wehinger 1, Barbara Schneider 4
PMCID: PMC6654077  PMID: 14743856

Abstract

Background: Patients with atrial fibrillation (AF) have a higher mortality and risk of stroke/embolism than patients with sinus rhythm.

Hypothesis: The aim of the study was to assess the association of clinical and echocardiographic characteristics with mortality and stroke/embolism and the use of antithrombotic medicationin the year 2000 in patients who participated 1990‐1995 in the Embolism in Left Atrial Thrombi (ELAT) study.

Methods: The study included 409 outpatients with non‐rheumatic AF (62 ± 12 years, 36% women, 39% intermittent AF). Patients with thrombi received anticoagulation, patients without thrombi aspirin until follow‐up in 1995; thereafter, anticoagulation according to clinical risk factors was recommended. Primary events were death and secondary events were stroke/embolism. All patients were contacted during the year 2000.

Results: Mean follow‐up was 102 months. Mortality was 4%/year; the cause of death was cardiac (n=84), fatal stroke (n = 26), malignancy (n = 23), sepsis (n = 5), and unknown (n = 24). Multivariate analysis identified age (p < 0.0001), heart failure (p = 0.0013), and reduced left ventricular systolic function (p = 0.0353) as predictors of mortality. Stroke/embolism occurred in 83 patients, with a rate of 3%/year. Multivariate analysis identified age (p = 0.0006) and previous stroke (p = 0.0454) as predictors of stroke/embolism. In the year 2000, 51 (21%) of the 247 surviving patients received no antithrombotic medication, 88 received (36%) oral anticoagulants, 102 (41%) acetylsalicylic acid, and 6 (2%) low‐molecular heparin.

Conclusions: Therapy for heart failure and oral anticoagulation in AF should be seriously considered, especially in elderly patients and in those with previous stroke.

Keywords: atrial fibrillation; heart failure; mortality, stroke; transesophageal echocardiography

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