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AF type is better stroke predictor

Pattern of atrial fibrillation (AF) is a strong independent predictor of stroke risk in non-anticoagulated patients, and may help to assess the risk/benefit for anticoagulant therapy, especially in lower risk patients, according to a study published recently in the European Heart Journal.1

The authors analysed the rates of stroke and systemic embolism in 6,563 aspirin-treated patients with AF from the ACTIVE-A/AVERROES databases, searching for events and adjudication. Multivariable analyses were performed with the adjustment for known risk factors for stroke. Mean age of patients with paroxysmal, persistent, and permanent AF was 69.0 ± 9.9, 68.6 ± 10.2, and 71.9 ± 9.8 years (P < 0.001). The CHA2DS2-VASc score was similar in patients with paroxysmal and persistent AF (3.1 ± 1.4), but was higher in patients with permanent AF (3.6 ± 1.5, P < 0.001).

Yearly ischaemic stroke rates were 2.1, 3.0, and 4.2% for paroxysmal, persistent, and permanent AF, respectively, with adjusted hazard ratio of 1.83 (P < 0.001) for permanent vs. paroxysmal and 1.44 (P = 0.02) for persistent vs. paroxysmal. Multivariable analysis identified age ≥75 year, sex, history of stroke or transient ischaemic attack (TIA), and AF pattern as independent predictors of stroke, with AF pattern being the second strongest predictor after prior stroke or TIA.

Speaking to BJC Arrhythmia Watch, lead author Professor Stuart Connolly (McMaster University, Ontario, Canada) said: “We reported that the risk of stroke with AF is lower if the AF is intermittent compared to permanent. The data are reasonably convincing but there could be other co-variates other than type of AF that might explain our findings.”

Professor Stuart Connolly (McMaster University, Ontario, Canada)

Professor Stuart Connolly (McMaster University, Ontario, Canada)

“The clinical implications are that in addition to usual risk stratification with the CHADS or CHA2DS2-VASC score, one can consider the type of AF in deciding whether or not to use an anticoagulant in some cases,” Professor Connolly concluded.

References

1. Vanassche T, Lauw MN, Eikelboom JW, et al. Risk of ischaemic stroke according to pattern of atrial fibrillation: analysis of 6563 aspirin-treated patients in ACTIVE-A and AVERROES. Eur Heart J 2015;36:281–8. http://dx.doi.org/10.1093/eurheartj/ehu307

Published on: February 25, 2015

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  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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