Risk of ischaemic stroke according to pattern ofatrial fibrillation: analysis of 6563 aspirin-treatedpatients in ACTIVE-A and AVERROES
Eur. heart j;
36: 281-287, 2015. ilus
Artigo
em Inglês
| SES-SP, SESSP-IDPCPROD, SES-SP | ID: biblio-1062637
The pattern of atrial fibrillation (AF) occurrenceparoxysmal, persistent, or permanentis associated with progressivestages of atrial dysfunction and structural changes and may therefore be associated with progressively higher stroke risk.However, previous studies have not consistently shown AF pattern to predict stroke but have been hampered bymethodological shortcomings of low power, variable event ascertainment, and variable anticoagulant use.Methodsand resultsWe analysed the rates of stroke and systemic embolism in 6563 aspirin-treated patients with AF from the ACTIVE-A/AVERROESdatabases. Therewas thorough searching for events and adjudication. Multivariable analyses were performedwith the adjustment for known risk factors for stroke. Mean age of patients with paroxysmal, persistent, and permanentAFwas 69.0+9.9, 68.6+10.2, and 71.9+9.8 years (P , 0.001). TheCHA2DS2-VASc scorewas similar in patients withparoxysmal and persistent AF (3.1+1.4), but was higher in patients with permanent AF (3.6+1.5, P , 0.001). Yearlyischaemic stroke rates were 2.1, 3.0, and 4.2% for paroxysmal, persistent, and permanent AF, respectively, with adjustedhazard ratio of 1.83 (P , 0.001) for permanent vs. paroxysmal and 1.44 (P » 0.02) for persistent vs. paroxysmal.Multivariable analysis identified age ≥ 75 year, sex, history of stroke or TIA, and AF pattern as independent predictorsof stroke, with AF pattern being the second strongest predictor after prior stroke or TIA.Conclusion In a large population of non-anticoagulated AF patients, pattern of AF was a strong independent predictor of stroke riskand may be helpful to assess the risk/benefit for anticoagulant therapy, especially in lower risk patients.
Biblioteca responsável:
BR79.1
Localização: BR79.1
Similares
