Features of cardioembolic stroke with persistent and paroxysmal atrial fibrillation – a study with the Japan Stroke Registry

BACKGROUND AND PURPOSE: The stroke severity on admission and clinical outcomes were compared between ischaemic stroke patients with non-valvular atrial fibrillation (NVAF) of the persistent (PeAF) and paroxysmal (PAF) types. METHODS: The study comprised 9293 patients with cardioembolic stroke and NVAF who were registered in the Japanese stroke databank: 6522 had PeAF (70.2%) and 2771 had PAF (29.8%). Stroke severity on admission and the clinical outcomes on discharge were retrospectively compared between these patient groups. RESULTS: The National Institutes of Health Stroke Scale score on admission (median, interquartile range) was 10 (3-20) for PeAF patients and 7 (2-17) for PAF patients, indicating that stroke severity on admission was significantly worse in PeAF patients than PAF patients (P < 0.001). Good outcomes (modified Rankin scale score ≤2) were achieved by 45% PeAF patients and 53% PAF patients. Thus, PeAF patients had significantly poorer clinical outcomes than PAF patients (P < 0.001). In-hospital mortality was significantly higher amongst PeAF patients (11%) than PAF patients (8%) (P < 0.001). Multivariate analysis of factors contributing to clinical outcomes showed that PeAF was a contributing factor for in-hospital mortality (odds ratio 1.261; 95% confidence interval 1.011-1.652; P = 0.045). CONCLUSIONS: Amongst cardioembolic stroke patients with NVAF, those with PeAF have significantly higher stroke severity on admission than those with PAF, and PeAF is a factor contributing to in-hospital mortality. Thus, our study suggests that the type of atrial fibrillation affects stroke severity and clinical outcomes following cerebral infarction.