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Strokes in paroxysmal atrial fibrillation have more favorable outcome than in permanent atrial fibrillation
Author(s) -
Staszewski J.,
Brodacki B.,
Tomczykiewicz K.,
Kotowicz J.,
Stepien A.
Publication year - 2009
Publication title -
acta neurologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.967
H-Index - 95
eISSN - 1600-0404
pISSN - 0001-6314
DOI - 10.1111/j.1600-0404.2008.01100.x
Subject(s) - medicine , atrial fibrillation , cardiology , prospective cohort study , stroke (engine) , confounding , diabetes mellitus , risk factor , heart failure , multivariate analysis , single center , endocrinology , mechanical engineering , engineering
Background – Permanent (ptAF) and paroxysmal (pxAF) atrial fibrillation carry similar risk of ischemic stroke (IS). Objective – Our aim was to compare the course of IS due to ptAF and pxAF. Methods – A prospective, single‐center study was conducted in patients with AF and acute IS with 6‐month follow‐up. Results – We included 178 patients: 70 (39%) with pxAF and 108 (61%) with ptAF. Compared with patients with ptAF, patients with pxAF more often presented with subcortical, mainly lacunar strokes (21% vs 8%, P = 0.01) and were less frequently dependent at discharge (16% vs 42%, P < 0.001) and after 6 months (16% vs 20%, P < 0.001). Strokes in patients with pxAF were more frequently categorized as non‐cardioembolic (35% vs 18%, P = 0.01). In the multivariate analysis, after adjustment for confounding factors (diabetes, chronic heart failure, high risk of thromboembolism and lack of prestroke anticoagulation), ptAF was an important risk factor for unfavorable short‐term (OR 5.4; P < 0.01) and long‐term outcomes (OR 2.6, P = 0.01) of IS. In all patients with AF, the occurrence of non‐cardioembolic stroke was related to a reduced risk of dependence or death in short‐term outcome (OR 0.4, P = 0.04) and marginally influenced long‐term outcome (OR 0.49, P = 0.09). Conclusions – The present study suggests that, compared with patients with ptAF, ISs in patients with pxAF have better outcomes.