Induruwa Isuru, Bhakta Shiv, Herlekar Rahul, Sur Roy Akangsha, Hajiev Saur, Warburton Elizabeth A, Khadjooi Kayvan, McCabe John J
Department of Stroke, Cambridge University Hospitals, Cambridge, UK.
Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
Eur Stroke J. 2025 Mar;10(1):145-152. doi: 10.1177/23969873241272631. Epub 2024 Aug 21.
Atrial fibrillation (AF) detected after stroke (AFDAS) may represent a distinct clinical entity to that of known AF (KAF). However, there is limited long-term outcome data available for patients with AFDAS. More information regarding prognosis in AFDAS is required to inform future trial design in these patients.
We used data (2015-2019) from a national prospective stroke registry of consecutive patients with acute ischaemic stroke and AF. AFDAS was defined as a new diagnosis of AF after stroke detected on electrocardiograph or cardiac monitoring. The co-primary endpoints were: (1) all-cause mortality; (2) recurrent major adverse cardiovascular events (MACE) at 3 years. Secondary endpoints were: (1) recurrent stroke; (2) functional outcome at discharge; (3) presence of co-existing stroke mechanisms.
583 patients were included. After a median follow-up of 2.65 years (cumulative 1064 person-years) 309 patients died and 23 had recurrent MACE. Compared with AFDAS, KAF was associated with a higher risk of all-cause mortality (adjusted Hazard Ratio (aHR) 1.56, 95% CI 1.12-2.18), a higher prevalence of co-existing stroke mechanisms (adjusted odds ratio (aOR) 2.28, 95% CI 1.14-4.59), but not poor functional outcome (aOR 1.61, 95% CI 0.98-2.64). A trend towards a higher risk of MACE was observed in patients with KAF, but this was limited by statistical power (aHR 2.90, 95% CI 0.67-12.51). All 14 recurrent strokes occurred in the KAF group (Log-rank = 0.03).
These data provide further evidence that AFDAS differs to KAF with respect to risk of recurrent stroke, MACE, and all-cause mortality.
卒中后检测到的心房颤动（AFDAS）可能代表一种与已知心房颤动（KAF）不同的临床实体。然而，关于AFDAS患者的长期结局数据有限。需要更多关于AFDAS预后的信息，以为这些患者未来的试验设计提供参考。
我们使用了来自一个全国性前瞻性卒中登记处的数据（2015 - 2019年），该登记处纳入了连续的急性缺血性卒中和心房颤动患者。AFDAS被定义为在心电图或心脏监测中检测到卒中后新诊断的心房颤动。共同主要终点为：（1）全因死亡率；（2）3年时复发性主要不良心血管事件（MACE）。次要终点为：（1）复发性卒中；（2）出院时的功能结局；（3）并存的卒中机制。
共纳入583例患者。中位随访2.65年（累积1064人年）后，309例患者死亡，23例发生复发性MACE。与AFDAS相比，KAF与更高的全因死亡率风险相关（调整后风险比（aHR）1.56，95%置信区间1.12 - 2.18），并存卒中机制的患病率更高（调整后比值比（aOR）2.28，95%置信区间1.14 - 4.59），但与不良功能结局无关（aOR 1.61，95%置信区间0.98 - 2.64）。在KAF患者中观察到MACE风险有升高趋势，但受统计效能限制（aHR 2.90，95%置信区间0.67 - 12.51）。所有14例复发性卒中均发生在KAF组（对数秩检验P = 0.03）。
这些数据进一步证明，AFDAS在复发性卒中、MACE和全因死亡率风险方面与KAF不同。
