Key result
A predictive grading score identified newly diagnosed atrial fibrillation in 13% of cryptogenic stroke patients, with a score of 0-1 highly predictive of the absence of atrial fibrillation.
Cohort (n=164)
A novel predictive score using age, prior CAD or stroke, and left atrial area can identify cryptogenic stroke patients at high risk for developing atrial fibrillation.
May support targeted AF monitoring in cryptogenic stroke; leaves open prospective validation before practice change.
BACKGROUND AND PURPOSE: A significant proportion of cryptogenic ischaemic strokes are due to paroxysmal atrial fibrillation (AF). As paroxysmal AF appears to inexorably progress to persistent or permanent AF, this study with long-term follow-up was designed to establish the profile of patients who developed AF after hospital discharge. METHODS: All patients with cryptogenic ischaemic stroke over a 1-year period were included (n = 164). Patients were prospectively followed up at the outpatient clinic. Information on long-term outcome included the presence of newly diagnosed AF (NDAF). A specific NDAF assessment was performed at least 2 years after the index stroke using a structured telephone interview. Baseline clinical, laboratory, and echocardiographic data of these patients were retrospectively recorded. Independent predictive factors were then used to produce a predictive grading score for NDAF, derived by logistic regression analysis. RESULTS: With a median follow-up of 854 days, 22 cases of NDAF (13%) were observed. On multivariate analysis, factors associated with NDAF were age ≥72 years (two points), history of coronary artery disease (one point) or stroke (one point), and left atrial area ≥16 cm(2) (two points) (total score ranging from 0 to 6). Patients with a score ≤1 point did not have NDAF during follow-up. CONCLUSIONS: In cryptogenic ischaemic stroke, the NDAF score can be used to target patients at high risk of developing AF after hospital discharge, as a score of 0-1 was highly predictive of the absence of NDAF during follow-up. These results need to be confirmed in prospective studies.
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Bugnicourt et al. (2012) conducted a cohort in Cryptogenic ischaemic stroke (n=164). Predictive grading score for NDAF was evaluated on Presence of newly diagnosed AF (NDAF). A predictive grading score identified newly diagnosed atrial fibrillation in 13% of cryptogenic stroke patients, with a score of 0-1 highly predictive of the absence of atrial fibrillation.
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