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Predictors of newly diagnosed atrial fibrillation in cryptogenic stroke: a cohort study
Author(s) -
Bugnicourt J.M.,
Flament M.,
Guillaumont M.P.,
Chillon J.M.,
Leclercq C.,
Canaple S.,
Lamy C.,
Godefroy O.
Publication year - 2013
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.12017
Subject(s) - medicine , atrial fibrillation , stroke (engine) , cardiology , prospective cohort study , logistic regression , ischaemic stroke , cohort , predictive value of tests , mechanical engineering , engineering
Background and purpose A significant proportion of cryptogenic ischaemic strokes are due to paroxysmal atrial fibrillation ( AF ). As paroxysmal AF appears to inexorably progress to persistent or permanent AF , this study with long‐term follow‐up was designed to establish the profile of patients who developed AF after hospital discharge. Methods All patients with cryptogenic ischaemic stroke over a 1‐year period were included ( n = 164). Patients were prospectively followed up at the outpatient clinic. Information on long‐term outcome included the presence of newly diagnosed AF ( NDAF ). A specific NDAF assessment was performed at least 2 years after the index stroke using a structured telephone interview. Baseline clinical, laboratory, and echocardiographic data of these patients were retrospectively recorded. Independent predictive factors were then used to produce a predictive grading score for NDAF , derived by logistic regression analysis. Results With a median follow‐up of 854 days, 22 cases of NDAF (13%) were observed. On multivariate analysis, factors associated with NDAF were age ≥72 years (two points), history of coronary artery disease (one point) or stroke (one point), and left atrial area ≥16 cm 2 (two points) (total score ranging from 0 to 6). Patients with a score ≤1 point did not have NDAF during follow‐up. Conclusions In cryptogenic ischaemic stroke, the NDAF score can be used to target patients at high risk of developing AF after hospital discharge, as a score of 0–1 was highly predictive of the absence of NDAF during follow‐up. These results need to be confirmed in prospective studies.