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Atrial Fibrillation Related and Unrelated Stroke Recurrence Among Ischemic Stroke Patients With Atrial Fibrillation

Authors
Kim, Bum JoonHwang, Yang-HaPark, Man-SeokKim, Joon-TaeChoi, Kang-HoJung, Jin-ManYu, SungwookKim, Chi KyungOh, KyungmiSong, Tae-JinKim, Yong-JaePark, Kwang-YeolKim, Jeong-MinPark, Jong-HoChoi, Jay CholChung, Jong-WonBang, Oh YoungKim, Gyeong-MoonHeo, Sung HyukSeo, Woo-Keun
Issue Date
21-10월-2021
Publisher
FRONTIERS MEDIA SA
Keywords
atrial fibrillation; cardioembolic brain infarction; recurrence; stroke; stroke mechanism
Citation
FRONTIERS IN NEUROLOGY, v.12
Indexed
SCIE
SCOPUS
Journal Title
FRONTIERS IN NEUROLOGY
Volume
12
URI
https://scholar.korea.ac.kr/handle/2021.sw.korea/136019
DOI
10.3389/fneur.2021.744607
ISSN
1664-2295
Abstract
Background: Ischemic stroke with atrial fibrillation (AF) may recur despite appropriate treatment. It may be AF-related or AF-unrelated. We compared the factors associated with AF-related and AF-unrelated recurrences among ischemic stroke patients with AF.Methods: Patients with ischemic stroke and AF were enrolled from 11 centers in Korea. Ischemic stroke recurrence was classified as AF-related if the lesion pattern was compatible with cardioembolism without significant stenosis or as AF-unrelated if the lesion was more likely due to small vessel disease or arterial stenosis. Factors associated with stroke recurrence (AF-related and AF-unrelated) were investigated.Results: Among the 2,239 patients, 115 (5.1%) experienced recurrence (75 AF-related and 40 AF-unrelated). Factors independently associated with any stroke recurrence included AF diagnosed before stroke, small subcortical infarctions, and small scattered lesions in a single vascular territory. Type of AF was associated with the type of stroke recurrence, with persistent AF being associated with AF-related stroke [hazard ratio (HR) = 2.94, 95% confidence interval (CI) 1.69-5.26; p < 0.001]. By contrast, paroxysmal AF (HR = 3.76, 95% CI 1.56-9.04; p = 0.003), AF diagnosed before stroke (HR = 2.38, 95% CI 1.19-4.55; p = 0.014), small scattered lesions in a single vascular territory (reference: corticosubcortical lesion, HR = 3.19, 95% CI 1.18-8.63; p = 0.022), and the use of antiplatelet agents (HR = 2.11, 95% CI 1.11-4.03; p = 0.024) were independently associated with AF-unrelated stroke.Conclusion: Persistent AF was more associated with AF-related stroke recurrence, whereas paroxysmal AF was more associated with AF-unrelated stroke recurrence. A scattered lesion in a single vascular territory may predict AF-unrelated stroke recurrence.
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