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Koga M, Yoshimura S, Hasegawa Y, Shibuya S, Ito Y, Matsuoka H, Takamatsu K, Nishiyama K, Todo K, Kimura K, Furui E, Terasaki T, Shiokawa Y, Kamiyama K, Takizawa S, Okuda S, Okada Y, Kameda T, Nagakane Y, Yagita Y, Kario K, Shiozawa M, Sato S, Yamagami H, Arihiro S, Toyoda K. Higher Risk of Ischemic Events in Secondary Prevention for Patients With Persistent Than Those With Paroxysmal Atrial Fibrillation. Stroke 2016; 47:2582-8. [DOI: 10.1161/strokeaha.116.013746] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 07/15/2016] [Indexed: 01/06/2023]
Abstract
Background and Purpose—
The discrimination between paroxysmal and sustained (persistent or permanent) atrial fibrillation (AF) has not been considered in the approach to secondary stroke prevention. We aimed to assess the differences in clinical outcomes between mostly anticoagulated patients with sustained and paroxysmal AF who had previous ischemic stroke or transient ischemic attack.
Methods—
Using data from 1192 nonvalvular AF patients with acute ischemic stroke or transient ischemic attack who were registered in the SAMURAI-NVAF study (Stroke Management With Urgent Risk-Factor Assessment and Improvement-Nonvalvular AF; a prospective, multicenter, observational study), we divided patients into those with paroxysmal AF and those with sustained AF. We compared clinical outcomes between the 2 groups.
Results—
The median follow-up period was 1.8 (interquartile range, 0.93–2.0) years. Of the 1192 patients, 758 (336 women; 77.9±9.9 years old) and 434 (191 women; 77.3±10.0 years old) were assigned to the sustained AF group and paroxysmal AF groups, respectively. After adjusting for sex, age, previous anticoagulation, and initial National Institutes of Health Stroke Scale score, sustained AF was negatively associated with 3-month independence (multivariable-adjusted odds ratio, 0.61; 95% confidence interval, 0.43–0.87;
P
=0.006). The annual rate of stroke or systemic embolism was 8.3 and 4.6 per 100 person-years, respectively (multivariable-adjusted hazard ratio, 1.95; 95% confidence interval, 1.26–3.14) and that of major bleeding events was 3.4 and 3.1, respectively (hazard ratio, 1.13; 95% confidence interval, 0.63–2.08).
Conclusions—
Among patients with previous ischemic stroke or transient ischemic attack, those with sustained AF had a higher risk of stroke or systemic embolism compared with those with paroxysmal AF.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01581502.
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Affiliation(s)
- Masatoshi Koga
- From the Division of Stroke Care Unit (M.K., S.A.), Department of Cerebrovascular Medicine (S.Y., M.S., S. Sato, K. Toyoda), and Department of Neurology (H.Y.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan (Y.H.); Department of Neurology, South Miyagi Medical Center, Ogawara, Japan (S. Shibuya); Department of Neurology, Toyota Memorial Hospital, Toyota, Japan (Y.I.); Department of Cerebrovascular
| | - Sohei Yoshimura
- From the Division of Stroke Care Unit (M.K., S.A.), Department of Cerebrovascular Medicine (S.Y., M.S., S. Sato, K. Toyoda), and Department of Neurology (H.Y.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan (Y.H.); Department of Neurology, South Miyagi Medical Center, Ogawara, Japan (S. Shibuya); Department of Neurology, Toyota Memorial Hospital, Toyota, Japan (Y.I.); Department of Cerebrovascular
| | - Yasuhiro Hasegawa
- From the Division of Stroke Care Unit (M.K., S.A.), Department of Cerebrovascular Medicine (S.Y., M.S., S. Sato, K. Toyoda), and Department of Neurology (H.Y.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan (Y.H.); Department of Neurology, South Miyagi Medical Center, Ogawara, Japan (S. Shibuya); Department of Neurology, Toyota Memorial Hospital, Toyota, Japan (Y.I.); Department of Cerebrovascular
| | - Satoshi Shibuya
- From the Division of Stroke Care Unit (M.K., S.A.), Department of Cerebrovascular Medicine (S.Y., M.S., S. Sato, K. Toyoda), and Department of Neurology (H.Y.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan (Y.H.); Department of Neurology, South Miyagi Medical Center, Ogawara, Japan (S. Shibuya); Department of Neurology, Toyota Memorial Hospital, Toyota, Japan (Y.I.); Department of Cerebrovascular
| | - Yasuhiro Ito
- From the Division of Stroke Care Unit (M.K., S.A.), Department of Cerebrovascular Medicine (S.Y., M.S., S. Sato, K. Toyoda), and Department of Neurology (H.Y.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan (Y.H.); Department of Neurology, South Miyagi Medical Center, Ogawara, Japan (S. Shibuya); Department of Neurology, Toyota Memorial Hospital, Toyota, Japan (Y.I.); Department of Cerebrovascular
| | - Hideki Matsuoka
- From the Division of Stroke Care Unit (M.K., S.A.), Department of Cerebrovascular Medicine (S.Y., M.S., S. Sato, K. Toyoda), and Department of Neurology (H.Y.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan (Y.H.); Department of Neurology, South Miyagi Medical Center, Ogawara, Japan (S. Shibuya); Department of Neurology, Toyota Memorial Hospital, Toyota, Japan (Y.I.); Department of Cerebrovascular
| | - Kazuhiro Takamatsu
- From the Division of Stroke Care Unit (M.K., S.A.), Department of Cerebrovascular Medicine (S.Y., M.S., S. Sato, K. Toyoda), and Department of Neurology (H.Y.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan (Y.H.); Department of Neurology, South Miyagi Medical Center, Ogawara, Japan (S. Shibuya); Department of Neurology, Toyota Memorial Hospital, Toyota, Japan (Y.I.); Department of Cerebrovascular
| | - Kazutoshi Nishiyama
- From the Division of Stroke Care Unit (M.K., S.A.), Department of Cerebrovascular Medicine (S.Y., M.S., S. Sato, K. Toyoda), and Department of Neurology (H.Y.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan (Y.H.); Department of Neurology, South Miyagi Medical Center, Ogawara, Japan (S. Shibuya); Department of Neurology, Toyota Memorial Hospital, Toyota, Japan (Y.I.); Department of Cerebrovascular
| | - Kenichi Todo
- From the Division of Stroke Care Unit (M.K., S.A.), Department of Cerebrovascular Medicine (S.Y., M.S., S. Sato, K. Toyoda), and Department of Neurology (H.Y.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan (Y.H.); Department of Neurology, South Miyagi Medical Center, Ogawara, Japan (S. Shibuya); Department of Neurology, Toyota Memorial Hospital, Toyota, Japan (Y.I.); Department of Cerebrovascular
| | - Kazumi Kimura
- From the Division of Stroke Care Unit (M.K., S.A.), Department of Cerebrovascular Medicine (S.Y., M.S., S. Sato, K. Toyoda), and Department of Neurology (H.Y.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan (Y.H.); Department of Neurology, South Miyagi Medical Center, Ogawara, Japan (S. Shibuya); Department of Neurology, Toyota Memorial Hospital, Toyota, Japan (Y.I.); Department of Cerebrovascular
| | - Eisuke Furui
- From the Division of Stroke Care Unit (M.K., S.A.), Department of Cerebrovascular Medicine (S.Y., M.S., S. Sato, K. Toyoda), and Department of Neurology (H.Y.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan (Y.H.); Department of Neurology, South Miyagi Medical Center, Ogawara, Japan (S. Shibuya); Department of Neurology, Toyota Memorial Hospital, Toyota, Japan (Y.I.); Department of Cerebrovascular
| | - Tadashi Terasaki
- From the Division of Stroke Care Unit (M.K., S.A.), Department of Cerebrovascular Medicine (S.Y., M.S., S. Sato, K. Toyoda), and Department of Neurology (H.Y.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan (Y.H.); Department of Neurology, South Miyagi Medical Center, Ogawara, Japan (S. Shibuya); Department of Neurology, Toyota Memorial Hospital, Toyota, Japan (Y.I.); Department of Cerebrovascular
| | - Yoshiaki Shiokawa
- From the Division of Stroke Care Unit (M.K., S.A.), Department of Cerebrovascular Medicine (S.Y., M.S., S. Sato, K. Toyoda), and Department of Neurology (H.Y.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan (Y.H.); Department of Neurology, South Miyagi Medical Center, Ogawara, Japan (S. Shibuya); Department of Neurology, Toyota Memorial Hospital, Toyota, Japan (Y.I.); Department of Cerebrovascular
| | - Kenji Kamiyama
- From the Division of Stroke Care Unit (M.K., S.A.), Department of Cerebrovascular Medicine (S.Y., M.S., S. Sato, K. Toyoda), and Department of Neurology (H.Y.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan (Y.H.); Department of Neurology, South Miyagi Medical Center, Ogawara, Japan (S. Shibuya); Department of Neurology, Toyota Memorial Hospital, Toyota, Japan (Y.I.); Department of Cerebrovascular
| | - Shunya Takizawa
- From the Division of Stroke Care Unit (M.K., S.A.), Department of Cerebrovascular Medicine (S.Y., M.S., S. Sato, K. Toyoda), and Department of Neurology (H.Y.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan (Y.H.); Department of Neurology, South Miyagi Medical Center, Ogawara, Japan (S. Shibuya); Department of Neurology, Toyota Memorial Hospital, Toyota, Japan (Y.I.); Department of Cerebrovascular
| | - Satoshi Okuda
- From the Division of Stroke Care Unit (M.K., S.A.), Department of Cerebrovascular Medicine (S.Y., M.S., S. Sato, K. Toyoda), and Department of Neurology (H.Y.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan (Y.H.); Department of Neurology, South Miyagi Medical Center, Ogawara, Japan (S. Shibuya); Department of Neurology, Toyota Memorial Hospital, Toyota, Japan (Y.I.); Department of Cerebrovascular
| | - Yasushi Okada
- From the Division of Stroke Care Unit (M.K., S.A.), Department of Cerebrovascular Medicine (S.Y., M.S., S. Sato, K. Toyoda), and Department of Neurology (H.Y.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan (Y.H.); Department of Neurology, South Miyagi Medical Center, Ogawara, Japan (S. Shibuya); Department of Neurology, Toyota Memorial Hospital, Toyota, Japan (Y.I.); Department of Cerebrovascular
| | - Tomoaki Kameda
- From the Division of Stroke Care Unit (M.K., S.A.), Department of Cerebrovascular Medicine (S.Y., M.S., S. Sato, K. Toyoda), and Department of Neurology (H.Y.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan (Y.H.); Department of Neurology, South Miyagi Medical Center, Ogawara, Japan (S. Shibuya); Department of Neurology, Toyota Memorial Hospital, Toyota, Japan (Y.I.); Department of Cerebrovascular
| | - Yoshinari Nagakane
- From the Division of Stroke Care Unit (M.K., S.A.), Department of Cerebrovascular Medicine (S.Y., M.S., S. Sato, K. Toyoda), and Department of Neurology (H.Y.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan (Y.H.); Department of Neurology, South Miyagi Medical Center, Ogawara, Japan (S. Shibuya); Department of Neurology, Toyota Memorial Hospital, Toyota, Japan (Y.I.); Department of Cerebrovascular
| | - Yoshiki Yagita
- From the Division of Stroke Care Unit (M.K., S.A.), Department of Cerebrovascular Medicine (S.Y., M.S., S. Sato, K. Toyoda), and Department of Neurology (H.Y.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan (Y.H.); Department of Neurology, South Miyagi Medical Center, Ogawara, Japan (S. Shibuya); Department of Neurology, Toyota Memorial Hospital, Toyota, Japan (Y.I.); Department of Cerebrovascular
| | - Kazuomi Kario
- From the Division of Stroke Care Unit (M.K., S.A.), Department of Cerebrovascular Medicine (S.Y., M.S., S. Sato, K. Toyoda), and Department of Neurology (H.Y.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan (Y.H.); Department of Neurology, South Miyagi Medical Center, Ogawara, Japan (S. Shibuya); Department of Neurology, Toyota Memorial Hospital, Toyota, Japan (Y.I.); Department of Cerebrovascular
| | - Masayuki Shiozawa
- From the Division of Stroke Care Unit (M.K., S.A.), Department of Cerebrovascular Medicine (S.Y., M.S., S. Sato, K. Toyoda), and Department of Neurology (H.Y.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan (Y.H.); Department of Neurology, South Miyagi Medical Center, Ogawara, Japan (S. Shibuya); Department of Neurology, Toyota Memorial Hospital, Toyota, Japan (Y.I.); Department of Cerebrovascular
| | - Shoichiro Sato
- From the Division of Stroke Care Unit (M.K., S.A.), Department of Cerebrovascular Medicine (S.Y., M.S., S. Sato, K. Toyoda), and Department of Neurology (H.Y.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan (Y.H.); Department of Neurology, South Miyagi Medical Center, Ogawara, Japan (S. Shibuya); Department of Neurology, Toyota Memorial Hospital, Toyota, Japan (Y.I.); Department of Cerebrovascular
| | - Hiroshi Yamagami
- From the Division of Stroke Care Unit (M.K., S.A.), Department of Cerebrovascular Medicine (S.Y., M.S., S. Sato, K. Toyoda), and Department of Neurology (H.Y.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan (Y.H.); Department of Neurology, South Miyagi Medical Center, Ogawara, Japan (S. Shibuya); Department of Neurology, Toyota Memorial Hospital, Toyota, Japan (Y.I.); Department of Cerebrovascular
| | - Shoji Arihiro
- From the Division of Stroke Care Unit (M.K., S.A.), Department of Cerebrovascular Medicine (S.Y., M.S., S. Sato, K. Toyoda), and Department of Neurology (H.Y.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan (Y.H.); Department of Neurology, South Miyagi Medical Center, Ogawara, Japan (S. Shibuya); Department of Neurology, Toyota Memorial Hospital, Toyota, Japan (Y.I.); Department of Cerebrovascular
| | - Kazunori Toyoda
- From the Division of Stroke Care Unit (M.K., S.A.), Department of Cerebrovascular Medicine (S.Y., M.S., S. Sato, K. Toyoda), and Department of Neurology (H.Y.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan (Y.H.); Department of Neurology, South Miyagi Medical Center, Ogawara, Japan (S. Shibuya); Department of Neurology, Toyota Memorial Hospital, Toyota, Japan (Y.I.); Department of Cerebrovascular
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