Key result
Increasing age links to ~90% higher AF risk per decade in cryptogenic stroke patients with ICM.
Cohort (n=221)
Effect estimate: HR 1.9 (95% CI 1.3-2.8)
p-value: p=0.0009
Increasing age and prolonged PR interval are independent predictors of atrial fibrillation detection in cryptogenic stroke patients monitored with an insertable cardiac monitor, though they offer only moderate predictive ability.
May support AF risk stratification by age and PR interval in cryptogenic stroke; leaves open prospective validation for ICM use.
OBJECTIVE: We assessed predictors of atrial fibrillation (AF) in cryptogenic stroke (CS) or transient ischemic attack (TIA) patients who received an insertable cardiac monitor (ICM). METHODS: We studied patients with CS/TIA who were randomized to ICM within the CRYSTAL AF study. We assessed whether age, sex, race, body mass index, type and severity of index ischemic event, CHADS2 score, PR interval, and presence of diabetes, hypertension, congestive heart failure, or patent foramen ovale and premature atrial contractions predicted AF development within the initial 12 and 36 months of follow-up using Cox proportional hazards models. RESULTS: Among 221 patients randomized to ICM (age 61.6 ± 11.4 years, 64% male), AF episodes were detected in 29 patients within 12 months and 42 patients at 36 months. Significant univariate predictors of AF at 12 months included age (hazard ratio [HR] per decade 2.0 [95% confidence interval 1.4-2.8], p = 0.002), CHADS2 score (HR 1.9 per one point [1.3-2.8], p = 0.008), PR interval (HR 1.3 per 10 milliseconds [1.2-1.4], p < 0.0001), premature atrial contractions (HR 3.9 for >123 vs 0 [1.3-12.0], p = 0.009 across quartiles), and diabetes (HR 2.3 [1.0-5.2], p < 0.05). In multivariate analysis, age (HR per decade 1.9 [1.3-2.8], p = 0.0009) and PR interval (HR 1.3 [1.2-1.4], p < 0.0001) remained significant and together yielded an area under the receiver operating characteristic curve of 0.78 (0.70-0.85). The same predictors were found at 36 months. CONCLUSION: Increasing age and a prolonged PR interval at enrollment were independently associated with an increased AF incidence in CS patients. However, they offered only moderate predictive ability in determining which CS patients had AF detected by the ICM.
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Thijs et al. (2015) conducted a cohort in Cryptogenic stroke or transient ischemic attack (n=221). Insertable cardiac monitor (ICM) was evaluated on Atrial fibrillation development within 12 months (multivariate predictor: age per decade) (HR 1.9, 95% CI 1.3-2.8, p=0.0009). Increasing age (HR 1.9 per decade) and prolonged PR interval (HR 1.3 per 10 ms) were independently associated with increased AF incidence in cryptogenic stroke patients with an ICM.
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