The type of atrial fibrillation is associated with long-term outcome in patients with acute ischemic stroke

Int J Cardiol. 2013 Aug 20;167(4):1519-23. doi: 10.1016/j.ijcard.2012.04.131. Epub 2012 May 17.


Background/objectives: We aimed to investigate the association between the type of atrial fibrillation (AF) and long-term outcome in terms of mortality and stroke recurrence in patients with ischemic stroke and non-valvular AF.

Methods: All consecutive patients admitted with acute ischemic stroke to Alexandra Hospital between 1993 and 2010 were included in the analysis. Patients were categorized in 3 groups according to the type of AF (paroxysmal, persistent, and permanent) and were followed up for up to 10 years after the index stroke or until death. The endpoints were inhospital, 30-day and 10-year stroke recurrence, and 30-day and 10-year all-cause mortality. The Kaplan-Meier product limit method was used to estimate the probability of 10-year stroke recurrence and survival. Multivariate Cox proportional hazard models were used to identify significant predictors of stroke recurrence and all-cause mortality.

Results: There were 811 patients (419 females, 392 males) with non-valvular AF and mean age of 75.8 ± 9.4 years. 277 (34.2%) patients had paroxysmal AF, 165 (20.3%) persistent and 369 (45.5%) permanent. Inhospital stroke recurrence rate was low (1.8%) and similar among the 3 patient groups; on the contrary, the probability of 10-year stroke recurrence was significantly higher in patients with permanent AF (p<0.01 by log-rank test). The probability of 10-year survival was significantly higher in patients with paroxysmal AF (p<0.001 by log-rank test). The type of AF was a significant predictor of 10-year stroke recurrence and mortality. Patients with permanent AF had higher risk of stroke recurrence (HR: 1.78, 95%CI: 1.21-2.61) and mortality (HR: 1.55, 95%CI: 1.20-1.99) compared to patients with paroxysmal AF.

Conclusions: Long-term outcome in stroke patients with AF is associated with the type of AF; patients with paroxysmal AF have lower rates of stroke recurrence and mortality.

Keywords: Atrial fibrillation; Paroxysmal; Permanent; Persistent; Stroke; Stroke recurrence.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Atrial Fibrillation / classification
  • Atrial Fibrillation / mortality*
  • Atrial Fibrillation / physiopathology*
  • Brain Ischemia / mortality*
  • Brain Ischemia / physiopathology*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Prospective Studies
  • Registries
  • Retrospective Studies
  • Stroke / mortality*
  • Stroke / physiopathology*
  • Survival Rate / trends
  • Treatment Outcome