Prior stroke and transient ischemic attack as risk factors for subsequent stroke in atrial fibrillation patients: a report from the GARFIELD-AF registry
Background: Its not always possible to verify whether a patient complaining of symptoms consistent with transient ischemic attack has had an actual cerebrovascular event.Research questionTo characterize the risk of cardiovascular events associated with a history of stroke/transient ischemic attack i...
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| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
2020
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| In: |
International journal of stroke
Year: 2020, Volume: 15, Issue: 3, Pages: 308-317 |
| ISSN: | 1747-4949 |
| DOI: | 10.1177/1747493019891516 |
| Online Access: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1177/1747493019891516 Verlag, lizenzpflichtig, Volltext: https://journals.sagepub.com/doi/10.1177/1747493019881353 
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| Author Notes: | Werner Hacke, Jean-Pierre Bassand, Saverio Virdone, A John Camm, David A Fitzmaurice, Keith AA Fox, Samuel Z Goldhaber, Shinya Goto, Sylvia Haas, Gloria Kayani, Lorenzo G Mantovani, Frank Misselwitz, Karen S Pieper, Alexander GG Turpie, Martin van Eickels, Freek WA Verheugt, Ajay K Kakkar |
| Summary: | Background: Its not always possible to verify whether a patient complaining of symptoms consistent with transient ischemic attack has had an actual cerebrovascular event.Research questionTo characterize the risk of cardiovascular events associated with a history of stroke/transient ischemic attack in patients with atrial fibrillation.Study design and methodsThis study investigated the clinical characteristics and outcomes of patients with a history of stroke/transient ischemic attack among 52,014 patients enrolled prospectively in GARFIELD-AF registry. The diagnosis of stroke or transient ischemic attack was not protocol defined but based on physicians? assessment. Patients? one-year risk of death, stroke/systemic embolism, and major bleeding was assessed by multivariable Cox regression.ResultsAt enrollment, 5617 (10.9%) patients were reported to have a history of stroke or transient ischemic attack. Patients with stroke or transient ischemic attack were older and had a greater burden of diabetes, moderate-to-severe kidney disease, and atherothrombosis and higher median CHA2DS2-VASc and HAS-BLED scores than those without history of stroke or transient ischemic attack. After adjustment, prior stroke/transient ischemic attack was associated with significantly higher risk for all-cause mortality (hazard ratio (HR), 1.26; 95% confidence interval (CI), 1.12?1.42), cardiovascular death (HR, 1.22; 95% CI, 1.01?1.48), non-cardiovascular death (HR, 1.39; 95% CI, 1.15?1.68), and stroke/systemic embolism (HR, 2.17; 95% CI, 1.80?2.63) than patients without history of stroke/transient ischemic attack. In patients with a prior stroke alone higher risk was observed for all-cause mortality (HR, 1.29; 95% CI, 1.11?1.50), non-cardiovascular death (HR, 1.39; 95% CI, 1.10?1.77), and stroke/systemic embolism (HR, 2.29; 95% CI, 1.83?2.86). No significantly elevated risk of adverse events was seen for patients with history of transient ischemic attack alone.InterpretationA history of prior stroke or transient ischemic attack is a strong independent risk factor for mortality and stroke/systemic embolism. This excess risk is mainly attributed to a history of stroke (with or without transient ischemic attack), whereas history of transient ischemic attack is a weaker predictor.Clinical trial registration: NCT01090362. |
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| Item Description: | Gesehen am 23.04.2020 First published December 17, 2019 |
| Physical Description: | Online Resource |
| ISSN: | 1747-4949 |
| DOI: | 10.1177/1747493019891516 |