Intracardiac thrombus (RR 1.99; 95% CI 1.38-2.87) and spontaneous left atrial appendage contrast (RR 2.91; 95% CI 1.21-6.17) were significantly associated with recurrent stroke in atrial fibrillation.
Systematic Review
Biomarkers of atrial cardiopathy, small vessel disease, and previous infarction, along with AF burden and stroke despite OAC, are associated with recurrent stroke in AF patients.
Estimación del efecto: RR 1.99 (95% CI 1.38-2.87)
BACKGROUND AND OBJECTIVES: Despite effective secondary prevention, including oral anticoagulant (OAC) therapy, the risk of recurrent stroke (RS) in patients with atrial fibrillation (AF) remains substantial with an annualized risk of 3.2%-6.5% per year. The reasons for this high residual risk are unclear. There is growing need for improved risk prediction tools to identify patients at greatest risk of RS in AF and to find new therapeutic targets for secondary prevention. Our objective was to perform a systematic review to investigate the association of clinical factors and echocardiographic, blood, and neuroimaging biomarkers, with stroke recurrence after AF-related stroke. METHODS: We searched Embase/Ovid Medline until August 2023. Studies were included irrespective of OAC use. Risk ratios (RRs) were pooled using random effects. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. RESULTS: ), intracardiac thrombus (RR 1.99, 1.38-2.87), spontaneous left atrial appendage (LAA) echocardiographic contrast (RR 2.91, 1.21-6.17), or low LAA intensity variation (RR 2.81, 1.48-5.32). Data were limited for blood biomarkers. DISCUSSION: We identified several clinical factors associated with recurrence after AF-related stroke, with AF burden and stroke despite OAC of particular clinical relevance. Biomarkers of atrial cardiopathy, small vessel disease, or previous infarction were also associated with RS. Collaborative efforts are needed to identify and validate new risk factors and biomarkers of RS in AF.
Cheung et al. (Wed,) conducted a systematic review in Atrial fibrillation with previous stroke. Clinical factors and biomarkers was evaluated on Recurrent stroke (RR 1.99, 95% CI 1.38-2.87). Intracardiac thrombus (RR 1.99; 95% CI 1.38-2.87) and spontaneous left atrial appendage contrast (RR 2.91; 95% CI 1.21-6.17) were significantly associated with recurrent stroke in atrial fibrillation.