Zietz, Annaelle; Polymeris, Alexandros A; Helfenstein, Fabrice; Schaedelin, Sabine; Hert, Lisa; Wagner, Benjamin; Seiffge, David J; Traenka, Christopher; Altersberger, Valerian L; Dittrich, Tolga; Kaufmann, Josefin; Ravanelli, Flavia; Fladt, Joachim; Fisch, Urs; Thilemann, Sebastian; De Marchis, Gian Marco; Gensicke, Henrik; Bonati, Leo H; Katan, Mira; Fischer, Urs; ... (2023). The impact of competing stroke etiologies in patients with atrial fibrillation. European stroke journal, 8(3), pp. 703-711. Sage 10.1177/23969873231185220
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BACKGROUND
Data on the impact of competing stroke etiologies in stroke patients with atrial fibrillation (AF) are scarce.
METHODS
We used prospectively obtained data from an observational registry (Novel-Oral-Anticoagulants-in-Ischemic-Stroke-Patients-(NOACISP)-LONGTERM) of consecutive AF-stroke patients treated with oral anticoagulants. We compared the frequency of (i) the composite outcome of recurrent ischemic stroke (IS), intracerebral hemorrhage (ICH) or all-cause death as well as (ii) recurrent IS alone among AF-stroke patients with versus without competing stroke etiologies according to the TOAST classification. We performed cox proportional hazards regression modeling adjusted for potential confounders. Furthermore, the etiology of recurrent IS was assessed.
RESULTS
Among 907 patients (median age 81, 45.6% female), 184 patients (20.3%) had competing etiologies, while 723 (79.7%) had cardioembolism as the only plausible etiology. During 1587 patient-years of follow-up, patients with additional large-artery atherosclerosis had higher rates of the composite outcome (adjusted HR [95% CI] 1.64 [1.11, 2.40], p = 0.017) and recurrent IS (aHR 2.96 [1.65, 5.35 ], p < 0.001), compared to patients with cardioembolism as the only plausible etiology. Overall 71 patients had recurrent IS (7.8%) of whom 26.7% had a different etiology than the index IS with large-artery-atherosclerosis (19.7%) being the most common non-cardioembolic cause.
CONCLUSION
In stroke patients with AF, causes other than cardioembolism as competing etiologies were common in index or recurrent IS. Concomitant presence of large-artery-atherosclerosis seems to indicate an increased risk for recurrences suggesting that stroke preventive means might be more effective if they also address competing stroke etiologies in AF-stroke patients.
CLINICAL TRIAL REGISTRATION
NCT03826927.
Item Type: |
Journal Article (Original Article) |
|---|---|
Division/Institute: |
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology 04 Faculty of Medicine > Pre-clinic Human Medicine > Department of Clinical Research (DCR) |
UniBE Contributor: |
Helfenstein, Fabrice Noël, Seiffge, David Julian |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
2396-9873 |
Publisher: |
Sage |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
04 Jul 2023 15:42 |
Last Modified: |
20 Feb 2024 14:15 |
Publisher DOI: |
10.1177/23969873231185220 |
PubMed ID: |
37401394 |
Uncontrolled Keywords: |
Stroke atrial fibrillation large artery atherosclerosis oral anticoagulation stroke etiology |
BORIS DOI: |
10.48350/184453 |
URI: |
https://boris.unibe.ch/id/eprint/184453 |
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