Fibrilação atrial e sua relação com eventos cerebrovasculares agudos

Abstract

Background: Atrial fibrillation (AF) is a potent risk factor for stroke. The presence of competing etiologies may modify disease outcomes and require different treatment strategies. Aims: The primary purpose of the study was to examine the differences in outcomes for patients with atrial fibrillation (AF) admitted with a recurrent stroke, stratified according to the presumed etiology of the stroke. Methods: We analyzed consecutive patients with AF admitted for a recurrent ischemic stroke in our academic comprehensive stroke center. Recurrent strokes were categorized as “Cardioembolic”, i.e., AF without any competing mechanism, versus “Undetermined” etiology due to competing mechanism(s). We used logistic regression to test the association between recurrent stroke etiology and favorable outcome (discharge home vs not), after accounting for important covariates. Results: We included 230 patients, mean age 76.9 (SD ±11.3), 52.2% male, median NIHSS 7 [IQR 2–16]. Patients with cardioembolic stroke (65.2%) had higher median NIHSS 8.5 [3-18] vs 3 [1-8] and were more likely to be treated with reperfusion therapies. Favorable outcome occurred in 64 patients (27.8%) and in-hospital mortality was 15.2% overall. After adjustment, there was no difference in outcome between patients with cardioembolic vs undetermined stroke etiology (Odds ratio for discharge home 1.41; 95% C.I., 0.65-3.15). Conclusions: In this single-center sample of patients with history of AF and stroke, there was no difference in discharge outcome between those with cardioembolic vs undetermined stroke etiology. This question warrants examination in larger samples to better understand the importance of the stroke mechanism and secondary prophylaxis.