Risk of ischaemic stroke according to pattern of atrial fibrillation: analysis of 6563 aspirin-treated patients in ACTIVE-A and AVERROES
Abstract
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.
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There is some evidence suggesting that AF burden may influence stroke risk.
“There is some evidence suggesting that AF burden may influence stroke risk 44,124,164 and could modify the response to rhythm control therapy.76,165”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [124]
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Cites
Dabigatran versus warfarin in patients with atrial fibrillation
Connolly, S. J., Ezekowitz, M. D., Yusuf, S., Eikelboom, J., Oldgren, J., Parekh, A., Pogue, J., Reilly, P. A., Themeles, E., Varrone, J., et al. (2009) · New England Journal of Medicine · doi:10.1056/nejmoa0905561 · Cited by 11,215 · see citing works
Rivaroxaban versus warfarin in nonvalvular atrial fibrillation
Patel, M. R., Mahaffey, K. W., Garg, J., Pan, G., Singer, D. E., Hacke, W., Breithardt, G., Halperin, J. L., Hankey, G. J., Piccini, J. P., et al. (2011) · New England Journal of Medicine · doi:10.1056/nejmoa1009638 · Cited by 9,430 · see citing works
Apixaban versus warfarin in patients with atrial fibrillation
Granger, C. B., Alexander, J. H., McMurray, J. J. V., Lopes, R. D., Hylek, E. M., Hanna, M., Al-Khalidi, H. R., Ansell, J., Atar, D., Avezum, A., et al. (2011) · New England Journal of Medicine · doi:10.1056/nejmoa1107039 · Cited by 8,943 · see citing works
Lip, G. Y. H., Nieuwlaat, R., Pisters, R., Lane, D. A., & Crijns, H. J. G. M. (2010) · Chest · doi:10.1378/chest.09-1584 · Cited by 6,879 · see citing works
Guidelines for the management of atrial fibrillation
Authors/Task Force Members, Camm, A. J., Kirchhof, P. F., Lip, G. Y. H., Schotten, U., Savelieva, I., Ernst, S., Gelder, I. C. V., Al‐Attar, N., Hindricks, G., et al. (2010) · European Heart Journal · doi:10.1093/eurheartj/ehq278 · Cited by 5,875 · see citing works
Edoxaban versus warfarin in patients with atrial fibrillation
Giugliano, R. P., Ruff, C. T., Braunwald, E., Murphy, S. A., Wiviott, S. D., Halperin, J. L., Waldo, A. L., Ezekowitz, M. D., Weitz, J. I., Špinar, J., et al. (2013) · New England Journal of Medicine · doi:10.1056/nejmoa1310907 · Cited by 5,164 · see citing works
Ruff, C. T., Giugliano, R. P., Braunwald, E., Hoffman, E. B., Deenadayalu, N., Ezekowitz, M. D., Camm, A. J., Weitz, J. I., Lewis, B. S., Parkhomenko, A., et al. (2014) · The Lancet · doi:10.1016/s0140-6736(13)62343-0 · Cited by 5,051 · see citing works
Gage, B. F., Waterman, A. D., Shannon, W., Boechler, M., Rich, M. W., & Radford, M. J. (2001) · JAMA · doi:10.1001/jama.285.22.2864 · Cited by 4,832 · see citing works
Hart, R. G., Pearce, L. A., & Aguilar, M. I. (2007) · Annals of Internal Medicine · doi:10.7326/0003-4819-146-12-200706190-00007 · Cited by 4,793 · see citing works
Epidemiologic Features of Chronic Atrial Fibrillation
Kannel, W. B., Abbott, R. D., Savage, D. D., & McNamara, P. M. (1982) · New England Journal of Medicine · doi:10.1056/nejm198204293061703 · Cited by 2,304 · see citing works
Subclinical atrial fibrillation and the risk of stroke
Healey, J. S., Connolly, S. J., Gold, M. R., Israel, C. W., Van Gelder, I. C., Capucci, A., Lau, C. P., Fain, E., Yang, S., Bailleul, C., et al. (2012) · New England Journal of Medicine · doi:10.1056/nejmoa1105575 · Cited by 2,100 · see citing works
The Boston Area Anticoagulation Trial for Atrial Fibrillation Investigators* (1990) · New England Journal of Medicine · doi:10.1056/nejm199011293232201 · Cited by 1,525 · see citing works
Wang, T. J., Massaro, J. M., Levy, D. A., Vasan, R. S., Wolf, P. A., D’Agostino, R. B., Larson, M. G., Kannel, W. B., & Benjamin, E. J. (2003) · JAMA · doi:10.1001/jama.290.8.1049 · Cited by 779 · see citing works
Fatkin, D., Kelly, R. P., & Feneley, M. P. (1994) · Journal of the American College of Cardiology · doi:10.1016/0735-1097(94)90644-0 · Cited by 771 · see citing works
Progression From Paroxysmal to Persistent Atrial Fibrillation
de Vos, C. B., Pisters, R., Nieuwlaat, R., Prins, M. H., Tieleman, R. G., Coelen, R. J. S., Heijkant, A. C. V. D., Allessie, M. A., & Crijns, H. J. G. M. (2010) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2009.11.040 · Cited by 720 · see citing works
Stroke with intermittent atrial fibrillation: incidence and predictors during aspirin therapy
Hart, R. G., Pearce, L. A., Rothbart, R. M., McAnulty, J. H., ASINGER, R. W., & Halperin, J. L. (2000) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(99)00489-1 · Cited by 662 · see citing works
Self-citationIndependent predictors of stroke in patients with atrial fibrillation
The Stroke Risk in Atrial Fibrillation Working Group (2007) · Neurology · doi:10.1212/01.wnl.0000267275.68538.8d · Cited by 545 · see citing works
Factors Associated With Ischemic Stroke During Aspirin Therapy in Atrial Fibrillation
Hart, R. G., Pearce, L. A., McBride, R., Rothbart, R. M., & ASINGER, R. W. (1999) · Stroke · doi:10.1161/01.str.30.6.1223 · Cited by 532 · see citing works
Self-citationPlatonov, P. G., Mitrofanova, L. B., Orshanskaya, V., & Ho, S. Y. (2011) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2011.05.061 · Cited by 496 · see citing works
Hohnloser, S. H., Pajitnev, D., Pogue, J. M., Healey, J. S., Pfeffer, M. A., Yusuf, S., & Connolly, S. J. (2007) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2007.07.076 · Cited by 459 · see citing works
Self-citationKakkar, A. K., Mueller, I., Bassand, J., Fitzmaurice, D. A., Goldhaber, S. Z., Goto, S., Haas, S. K., Hacke, W., Lip, G. Y. H., Mantovani, L. G., et al. (2013) · PLoS ONE · doi:10.1371/journal.pone.0063479 · Cited by 446 · see citing works
Hijazi, Z., Oldgren, J., Andersson, U., Connolly, S. J., Ezekowitz, M. D., Hohnloser, S. H., Reilly, P. A., Vinereanu, D., Siegbahn, A., Yusuf, S., et al. (2012) · Circulation · doi:10.1161/circulationaha.111.038729 · Cited by 402 · see citing works
Stroke in paroxysmal atrial fibrillation: report from the Stockholm Cohort of Atrial Fibrillation
Friberg, L., Hammar, N., & Rosenqvist, M. (2009) · European Heart Journal · doi:10.1093/eurheartj/ehn599 · Cited by 380 · see citing works
Chiang, C.-E., Naditch-Brûlé, L., Murin, J., Goethals, M., Inoue, H., O’Neill, J., Silva-Cardoso, J., Zharinov, O., Gamra, H., Alam, S., et al. (2012) · Circulation: Arrhythmia and Electrophysiology · doi:10.1161/circep.112.970749 · Cited by 327 · see citing works
Biomarkers in atrial fibrillation: a clinical review
Hijazi, Z., Oldgren, J., Siegbahn, A., Granger, C. B., & Wallentin, L. (2013) · European Heart Journal · doi:10.1093/eurheartj/eht024 · Cited by 298 · see citing works
Embolic complications in paroxysmal atrial fibrillation.
Petersen, P. B., & GODTFREDSEN, J. (1986) · Stroke · doi:10.1161/01.str.17.4.622 · Cited by 269 · see citing works
Left atrial structure and function in atrial fibrillation: ENGAGE AF-TIMI 48
Gupta, D. K., Shah, A. M., Giugliano, R. P., Ruff, C. T., Antman, E. M., Grip, L. T., Deenadayalu, N., Hoffman, E., Patel, I. J., Shi, M., et al. (2013) · European Heart Journal · doi:10.1093/eurheartj/eht500 · Cited by 210 · see citing works
The Efficacy of Aspirin in Patients With Atrial Fibrillation
(1997) · Archives of Internal Medicine · doi:10.1001/archinte.1997.00440320143013 · Cited by 208 · see citing works
Al‐Khatib, S. M., Thomas, L. E., Wallentin, L. C., Lópes, R. D., Gersh, B. J., Garcia, D. A., Ezekowitz, J. A., Alings, M., Yang, H., Alexander, J. H., et al. (2013) · European Heart Journal · doi:10.1093/eurheartj/eht135 · Cited by 192 · see citing works
Self-citationRoy, D., Marchand, E., Gagné, P., Chabot, M., & Cartier, R. (1986) · American Heart Journal · doi:10.1016/0002-8703(86)90318-2 · Cited by 166 · see citing works
Eikelboom, J. W., O'Donnell, M. J., Yusuf, S., Díaz, R., Flaker, G. C., Hart, R. G., Hohnloser, S. H., Joyner, C. D., Lawrence, J., Pais, P., et al. (2010) · American Heart Journal · doi:10.1016/j.ahj.2009.08.026 · Cited by 163 · see citing works
Self-citationLip, G. Y. H., Lowe, G. D. O., Rumley, A., & Dunn, F. G. (1996) · American Heart Journal · doi:10.1016/s0002-8703(96)90278-1 · Cited by 126 · see citing works
Nieuwlaat, R., Dinh, T., Olsson, S., Camm, A. J., Capucci, A., Tieleman, R. G., Lip, G. Y. H., Crijns, H. J. G. M., & on behalf of the Euro Heart Survey Investigators (2008) · European Heart Journal · doi:10.1093/eurheartj/ehn101 · Cited by 113 · see citing works
Scardi, S., Mazzone, C., Pandullo, C., Goldstein, D., Poletti, A., & Humar, F. (1999) · American Heart Journal · doi:10.1016/s0002-8703(99)70224-3 · Cited by 102 · see citing works
The ACTIVE Steering Committee (2006) · American Heart Journal · doi:10.1016/j.ahj.2005.06.026 · Cited by 99 · see citing works
Pattern of atrial fibrillation and risk of outcomes: the Loire Valley Atrial Fibrillation Project
Banerjee, A., Taillandier, S., Olesen, J. B., Lane, D. A., Lallemand, B., Lip, G. Y. H., & Fauchier, L. (2013) · International Journal of Cardiology · doi:10.1016/j.ijcard.2012.06.118 · Cited by 87 · see citing works
Flaker, G. C., Ezekowitz, M. D., Yusuf, S., Wallentin, L. C., Noack, H., Brueckmann, M., Reilly, P. A., Hohnloser, S. H., & Connolly, S. J. (2012) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2011.10.896 · Cited by 71 · see citing works
Self-citationRisk factors for stroke and other embolic events in patients with nonrheumatic atrial fibrillation.
Flegel, K. M., & Hanley, J. A. (1989) · Stroke · doi:10.1161/01.str.20.8.1000 · Cited by 71 · see citing works
ATRIAL FIBRILLATION AND STROKE IN ELDERLY HOSPITALIZED PATIENTS
Treseder, A. S., Sastry, B. S. D., Thomas, T. P. L., YATES, M. A., & PATHY, M. L. J. (1986) · Age and Ageing · doi:10.1093/ageing/15.2.89 · Cited by 70 · see citing works
Stroke event rates in anticoagulated patients with paroxysmal atrial fibrillation
Lip, G. Y. H., Frison, L., Grind, M., & the SPORTIF Investigators (2008) · Journal of Internal Medicine · doi:10.1111/j.1365-2796.2007.01909.x · Cited by 58 · see citing works
Disertori, M., Franzosi, M. G., Barlera, S., Cosmi, F., Quintarelli, S., Favero, C., Cappellini, G., Fabbri, G., Maggioni, A. P., Staszewsky, L. I., et al. (2013) · BMC Cardiovascular Disorders · doi:10.1186/1471-2261-13-28 · Cited by 50 · see citing works
Risk of cardiovascular and cerebrovascular events after atrial fibrillation diagnosis
Ruigómez, A., Johansson, S., Wallander, M.-A. A., Edvardsson, N. G., & Rodríguez, L. A. G. (2008) · International Journal of Cardiology · doi:10.1016/j.ijcard.2008.04.050 · Cited by 31 · see citing works
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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw210 · Cited by 6,418 · see citing works
Self-citation2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Journal of Cardio-Thoracic Surgery · doi:10.1093/ejcts/ezw313 · Cited by 1,403 · see citing works
Self-citationAtrial Fibrillation and Mechanisms of Stroke: Time for a New Model
Kamel, H., Okin, P. M., Elkind, M. S. V., & Iadecola, C. (2016) · Stroke · doi:10.1161/strokeaha.115.012004 · Cited by 627 · see citing works
Steinhubl, S. R., Waalen, J., Edwards, A. M., Ariniello, L. M., Mehta, R. R., Ebner, G. S., Carter, C., Baca-Motes, K., Felicione, E., Sarich, T., et al. (2018) · JAMA · doi:10.1001/jama.2018.8102 · Cited by 539 · see citing works
Turakhia, M. P., Ziegler, P. D., Schmitt, S. K., Chang, Y., Fan, J., Than, C. T., Keung, E. K., & Singer, D. E. (2015) · Circulation: Arrhythmia and Electrophysiology · doi:10.1161/circep.114.003057 · Cited by 197 · see citing works
Overvad, T. F., Skjøth, F., Lip, G. Y. H., Lane, D. A., Albertsen, I. E., Rasmussen, L. H., & Larsen, T. B. (2015) · Stroke · doi:10.1161/strokeaha.115.009371 · Cited by 87 · see citing works
Senoo, K., Lip, G. Y. H., Lane, D. A., Büller, H. R., & Kotecha, D. (2015) · Stroke · doi:10.1161/strokeaha.115.009487 · Cited by 64 · see citing works
- Authors
- Vanassche, T., Lauw, M. N., Eikelboom, J. W., Healey, J. S., Hart, R. G., Alings, M., Avezum, A., Diaz, R., Hohnloser, S. H., Lewis, B. S., Shestakovska, O., Wang, J., & Connolly, S. J.
- Affiliations
- Population Health Research Institute (CA)
- Amphia Ziekenhuis (NL)
- Goethe University Frankfurt (DE)
- Technion – Israel Institute of Technology (IL)
- Corresponding author
- Vanassche, T.
- ORCID
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-09-03
- Volume
- 36
- Issue
- 5
- Pages
- 281-288
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- OpenAlex
- W2163781421
- Cited by
- 313
- References
- 42
- Citations by year
- 2026: 10 · 2025: 16 · 2024: 19 · 2023: 18 · 2022: 19 · 2021: 19 · 2020: 27 · 2019: 34 · 2018: 41 · 2017: 42 · 2016: 40 · 2015: 25 · 2014: 3
- FWCI
- 25.13
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Bristol-Myers Squibb
- Pfizer
- Sanofi
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cardiovascular and Diving-Related Complications
- Keywords
- atrial fibrillation, ischemic stroke risk, paroxysmal atrial fibrillation, persistent atrial fibrillation, permanent atrial fibrillation, aspirin, non-anticoagulated patients, CHA2DS2-VASc score, systemic embolism, anticoagulation decision-making
- MeSH terms
- Aged, Aspirin, Atrial Fibrillation, Brain Ischemia, Double-Blind Method, Embolism, Female, Fibrinolytic Agents, Humans, Male, Risk Factors, Sex Distribution, Stroke, Kaplan-Meier Estimate
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