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The Known Cause Stroke and Underlying Atrial Fibrillation (STROKE AF) trial found that about one in eight patients with a recent ischemic stroke due to large/small vessel disease had atrial fibrillation (AF) after a stroke detected by a pluggable heart monitor (ICM)
at 12 months.
Identifying predictors of atrial fibrillation may be useful
when considering ICM for routine clinical care after stroke.
To determine the relationship between universally assessed risk factors and detection of new atrial fibrillation in the STROKE atrial fibrillation cohort monitored by ICM after stroke, in a pre-specified analysis of a randomized (1:1) clinical trial, index stroke in enrolled patients was attributed to macrovascular or small-vessel disease, aged over 60 years or aged 50-59 years, with at least one additional stroke risk factor
.
A total of 496 patients were enrolled and 492 were randomized to the study group
.
The main intervention was ICM monitoring versus site-specific usual care (short-term external cardiac monitoring).
The primary outcome was that ICM devices automatically detected episodes
of atrial fibrillation for 2 minutes or more.
The results showed that the analysis included 242 participants
randomized to the ICM group in the STROKE atrial fibrillation study.
Of the 242 patients monitored by ICM, 27 developed atrial fibrillation (mean [SD] age, 66.
6 [9.
3] years; 144 males [60.
0%]; 96 [40.
0%] females).
Univariate predictors for atrial fibrillation testing included age (increasing every 1 year: HR=1.
05; 95% CI, 1.
01-1.
09; P = .
02), CHA2DS2-VASc score (per score: HR = 1.
54; 95% CI, 1.
15-2.
06; P = .
004), chronic obstructive pulmonary disease (HR=2.
49; 95% CI, 0.
86-7.
20; P = .
09), and congestive heart failure (HR=6.
64; 95% CI, 2.
29-19.
24; P <.
001), left atrial enlargement (LAE; HR = 3.
63; 95% CI, 1.
55-8.
47; P = .
003), QRS time (HR = 1.
02; 95% CI, 1.
00 to 1.
04; P = .
04), and renal dysfunction (HR = 3.
58; 95% CI, 1.
35 to 9.
46; P = .
01).
In the multivariate model (n = 197), only CHF (HR = 5.
06; 95% CI, 1.
45-17.
64; P = .
05) and LAE (HR = 3.
32; 1.
34-8.
19; P = .
009) remained important predictors
of atrial fibrillation 。 At 12 months, the detection rate of atrial fibrillation was 23.
4% in patients with CHF and/or LAE (40 out of 142 patients) compared with 5.
0% in patients without either (HR = 5.
1; 95% CI, 2.
0-12.
8; P <.
001
).
In summary, CHF and LAE are significantly
associated with a significantly increased risk of testing for atrial fibrillation after stroke in patients with ischemic stroke due to macrovascular or small-vessel disease.
References:
Predictors of Atrial Fibrillation in Patients With Stroke Attributed to Large- or Small-Vessel Disease A Prespecified Secondary Analysis of the STROKE AF Randomized Clinical Trial.
