Permanent atrial fibrillation was associated with a higher yearly rate of ischaemic stroke compared to paroxysmal AF (4.2% vs 2.1%; adjusted HR 1.83, P<0.001) in aspirin-treated patients.
Cohort (n=6,563)
Does the pattern of atrial fibrillation (paroxysmal, persistent, or permanent) predict the risk of ischaemic stroke in non-anticoagulated, aspirin-treated patients?
In non-anticoagulated patients with AF, the pattern of AF (permanent > persistent > paroxysmal) is a strong independent predictor of stroke risk.
Effect estimate: HR 1.83
Absolute Event Rate: 4.2% vs 2.1%
p-value: p=<0.001
AIMS: The pattern of atrial fibrillation (AF) occurrence-paroxysmal, persistent, or permanent-is associated with progressive stages of atrial dysfunction and structural changes and may therefore be associated with progressively higher stroke risk. However, previous studies have not consistently shown AF pattern to predict stroke but have been hampered by methodological shortcomings of low power, variable event ascertainment, and variable anticoagulant use. METHODS AND RESULTS: We analysed the rates of stroke and systemic embolism in 6563 aspirin-treated patients with AF from the ACTIVE-A/AVERROES databases. There was thorough 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 TIA, and AF pattern as independent predictors of stroke, with AF pattern being the second strongest predictor after prior stroke or TIA. CONCLUSION: In a large population of non-anticoagulated AF patients, pattern of AF was a strong independent predictor of stroke risk and may be helpful to assess the risk/benefit for anticoagulant therapy, especially in lower risk patients.
Vanassche et al. (2014) conducted a cohort in Atrial fibrillation (n=6,563). Permanent atrial fibrillation vs. Paroxysmal atrial fibrillation was evaluated on Ischaemic stroke (HR 1.83, p=<0.001). Permanent atrial fibrillation was associated with a higher yearly rate of ischaemic stroke compared to paroxysmal AF (4.2% vs 2.1%; adjusted HR 1.83, P<0.001) in aspirin-treated patients.