Predictors for atrial fibrillation detection after cryptogenic stroke: Results from CRYSTAL AF
Open accessAbstract
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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AF detection is more likely in patients with cryptogenic stroke implanted with loop recorders or who have had ECG monitors for several weeks.
“AF detection is not uncommon in unselected stroke patients (6.2%, 95% CI 4.4-8.3),128 but is more likely in patients with cryptogenic stroke implanted with loop recorders or who have had ECG monitors for several weeks.18,128,152”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [152]
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Cites
Vandenbroucke, J. P., von Elm, E., Altman, D. G., Gøtzsche, P. C., Mulrow, C. D., Pocock, S. J., Poole, C., Schlesselman, J. J., Egger, M., & Initiative, F. T. S. (2007) · PLoS Medicine · doi:10.1371/journal.pmed.0040297 · Cited by 8,613 · see citing works
Vandenbroucke, J. P., Elm, E. V., Altman, D. G., Gøtzsche, P. C., Mulrow, C. D., Pocock, S. J., Poole, C., Schlesselman, J. J., Egger, M., & initiative, F. T. S. (2007) · Annals of Internal Medicine · doi:10.7326/0003-4819-147-8-200710160-00010-w1 · Cited by 3,543 · see citing works
Simplified calculation of body surface area
(1987) · New England Journal of Medicine · doi:10.1056/nejm198710223171717 · Cited by 3,238 · see citing works
Benjamin, E. J. (1994) · JAMA · doi:10.1001/jama.1994.03510350050036 · Cited by 2,613 · see citing works
Cryptogenic stroke and underlying atrial fibrillation
Sanna, T., Diener, H.-C., Passman, R. S., Di Lazzaro, V., Bernstein, R. A., Morillo, C. A., Rymer, M. M., Thijs, V., Rogers, T., Beckers, F., et al. (2014) · New England Journal of Medicine · doi:10.1056/nejmoa1313600 · Cited by 2,161 · see citing works
Self-citationUno, H., Cai, T., Pencina, M. J., D'Agostino, R. B., & Wei, L. J. (2011) · Statistics in Medicine · doi:10.1002/sim.4154 · Cited by 1,535 · see citing works
Atrial fibrillation in patients with cryptogenic stroke
Gladstone, D. J., Spring, M., Dorian, P., Panzov, V., Thorpe, K. E., Hall, J., Vaid, H., O'Donnell, M., Laupacis, A., Côté, R., et al. (2014) · New England Journal of Medicine · doi:10.1056/nejmoa1311376 · Cited by 1,276 · see citing works
Low Serum Thyrotropin Concentrations as a Risk Factor for Atrial Fibrillation in Older Persons
Sawin, C. T., Geller, A., Wolf, P. A., Belanger, A. J., Baker, E., Bacharach, P., Wilson, P., Benjamin, E. J., & D'Agostino, R. B. (1994) · New England Journal of Medicine · doi:10.1056/nejm199411103311901 · Cited by 1,259 · cited 7× · see citing works
“Unauthorized reproduction of this article is prohibited. markers such as thyroid function that associate with AF.11 The presence of vascular disease at baseline was not collected, and hence we were not able to use the CHA2DS2-VASc scoring system.”
MethodInfluentialLeft Atrial Size and the Risk of Stroke and Death
Benjamin, E. J., D’Agostino, R. B., Belanger, A. J., Wolf, P. A., & Levy, D. A. (1995) · Circulation · doi:10.1161/01.cir.92.4.835 · Cited by 1,058 · see citing works
Schnabel, R. B., SULLIVAN, L. M., Levy, D. A., Pencina, M. J., Massaro, J. M., D’Agostino, R. B., Newton‐Cheh, C., Yamamoto, J. F., Magnani, J. W., Tadros, T. M., et al. (2009) · The Lancet · doi:10.1016/s0140-6736(09)60443-8 · Cited by 1,038 · see citing works
Variants conferring risk of atrial fibrillation on chromosome 4q25
Gudbjartsson, D. F., Arnar, D. O., Helgadottir, A., Gretarsdottir, S., Holm, H., Sigurdsson, A., Jonasdottir, A., Baker, A., Thorleifsson, G., Kristjansson, K., et al. (2007) · Nature · doi:10.1038/nature06007 · Cited by 955 · see citing works
Interatrial septal abnormalities and stroke
Overell, J. R., Bone, I., & Lees, K. R. (2000) · Neurology · doi:10.1212/wnl.55.8.1172 · Cited by 937 · see citing works
Huxley, R. R., Lopez, F. L., Folsom, A. R., Agarwal, S. K., Loehr, L. R., Soliman, E. Z., Maclehose, R., Konety, S., & Alonso, A. (2011) · Circulation · doi:10.1161/circulationaha.110.009035 · Cited by 697 · see citing works
Long-term Outcomes in Individuals With Prolonged PR Interval or First-Degree Atrioventricular Block
Cheng, S. (2009) · JAMA · doi:10.1001/jama.2009.888 · Cited by 614 · see citing works
Parental atrial fibrillation as a risk factor for atrial fibrillation in offspring
Fox, C. S. (2004) · JAMA · doi:10.1001/jama.291.23.2851 · Cited by 600 · see citing works
Genome-wide association study of PR interval
Pfeufer, A., van Noord, C., Marciante, K. D., Arking, D. E., Larson, M. G., Smith, A. V., Tarasov, K. V., Müller‐Nurasyid, M., Sotoodehnia, N., Sinner, M. F., et al. (2010) · Nature Genetics · doi:10.1038/ng.517 · Cited by 434 · see citing works
Watanabe, H., Tanabe, N., Watanabe, T., Darbar, D., Roden, D. M., Sasaki, S., & Aizawa, Y. (2008) · Circulation · doi:10.1161/circulationaha.107.744466 · Cited by 427 · see citing works
Hindricks, G., Pokushalov, E., Urban, L., Taborsky, M., Kuck, K.-H., Lebedev, D., Rieger, G., & Pürerfellner, H. (2010) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.109.877852 · Cited by 422 · see citing works
Pulse Pressure and Risk of New-Onset Atrial Fibrillation
Mitchell, G. F., Vasan, R. S., Keyes, M. J., Parise, H., Wang, T. J., Larson, M. G., D’Agostino, R. B., Kannel, W. B., Levy, D. A., & Benjamin, E. J. (2007) · JAMA · doi:10.1001/jama.297.7.709 · Cited by 362 · see citing works
Long-term alcohol consumption and the risk of atrial fibrillation in the Framingham Study
Djoussé, L., Levy, D. A., Benjamin, E. J., Blease, S. J., Russ, A., Larson, M. G., Massaro, J. M., D’Agostino, R. B., Wolf, P. A., & Ellison, R. C. (2004) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2003.12.004 · Cited by 295 · see citing works
Schnabel, R. B., Larson, M. G., Yamamoto, J. F., SULLIVAN, L. M., Pencina, M. J., Meigs, J. B., Tofler, G. H., Selhub, J., Jacques, P. F., Wolf, P. A., et al. (2010) · Circulation · doi:10.1161/circulationaha.109.882241 · Cited by 290 · see citing works
Soliman, E. Z., Prineas, R. J., Case, L. D., Zhang, Z., & Goff, D. C. (2009) · Stroke · doi:10.1161/strokeaha.108.534735 · Cited by 281 · see citing works
Risk of New-Onset Atrial Fibrillation in Relation to Body Mass Index
Dublin, S. (2006) · Archives of Internal Medicine · doi:10.1001/archinte.166.21.2322 · Cited by 268 · see citing works
Berthet, K., Lavergne, T., Cohen, A. A., et al. (2000) · Stroke · doi:10.1161/01.str.31.2.398 · Cited by 259 · see citing works
The signal-averaged P wave duration: A rapid and noninvasive marker of risk of atrial fibrillation
Guidera, S. A., & Steinberg, J. S. (1993) · Journal of the American College of Cardiology · doi:10.1016/0735-1097(93)90381-a · Cited by 235 · see citing works
Atrial Premature Beats Predict Atrial Fibrillation in Cryptogenic Stroke
Gladstone, D. J., Dorian, P., Spring, M., Panzov, V., Mamdani, M., Healey, J. S., Thorpe, K. E., Aviv, R. I., Boyle, K., Blakely, J. A., et al. (2015) · Stroke · doi:10.1161/strokeaha.115.008714 · Cited by 200 · see citing works
Book ReviewNeuroanatomy: An atlas of structures, sections and systems
O’Rahilly, R. (1987) · New England Journal of Medicine · doi:10.1056/nejm198710223171718 · Cited by 198 · see citing works
Magnani, J. W., Johnson, V. M., SULLIVAN, L. M., Gorodeski, E. Z., Schnabel, R. B., Lubitz, S. A., Levy, D. A., Ellinor, P. T., & Benjamin, E. J. (2011) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2010.10.075 · Cited by 167 · see citing works
Predictors of Finding Occult Atrial Fibrillation After Cryptogenic Stroke
Favilla, C. G., Ingala, E., Jara, J., Fessler, E. B., Cucchiara, B. L., Messe, S. R., Mullen, M. T., Prasad, A., Siegler, J. E., Hutchinson, M. D., et al. (2015) · Stroke · doi:10.1161/strokeaha.114.007763 · Cited by 136 · see citing works
Electrocardiographic predictors of atrial fibrillation
Perez, M. V., Dewey, F. E., Marcus, R. R., Ashley, E. A., Al‐Ahmad, A., Wang, P. J., & Froelicher, V. F. (2009) · American Heart Journal · doi:10.1016/j.ahj.2009.08.002 · Cited by 134 · see citing works
Cryptogenic Stroke and underlying Atrial Fibrillation (CRYSTAL AF): Design and rationale
Sinha, A. M., Diener, H., Morillo, C. A., Sanna, T., Bernstein, R. A., Lazzaro, V. D., PASSMAN, R. S., Beckers, F., & Brachmann, J. (2010) · American Heart Journal · doi:10.1016/j.ahj.2010.03.032 · Cited by 134 · see citing works
Self-citationNielsen, J. B., Pietersen, A., Graff, C., Lind, B., Struijk, J. J., Olesen, M. S., Haunsø, S., Gerds, T. A., Ellinor, P. T., Køber, L., et al. (2013) · Heart Rhythm · doi:10.1016/j.hrthm.2013.04.012 · Cited by 126 · see citing works
Score for the Targeting of Atrial Fibrillation (STAF)
Suissa, L., Bertora, D., Lachaud, S., & Mahagne, M. H. (2009) · Stroke · doi:10.1161/strokeaha.109.552679 · Cited by 126 · see citing works
Scheitz, J. F., Erdur, H., Hæusler, K. G., Audebert, H. J., Roser, M., Laufs, U., Endres, M., & Nolte, C. H. (2015) · Stroke · doi:10.1161/strokeaha.115.008681 · Cited by 102 · see citing works
High pro-BNP levels predict the occurrence of atrial fibrillation after cryptogenic stroke
Rodríguez‐Yáñez, M., Rivas, S. A., Santamaría-Cadavid, M., Sobrino, T., Castillo, J., & Blanco, M. (2013) · Neurology · doi:10.1212/wnl.0b013e31829d8773 · Cited by 87 · see citing works
A Global Goodness‐of‐Fit Statistic for Cox Regression Models
Parzen, M. I., & Lipsitz, S. R. (1999) · Biometrics · doi:10.1111/j.0006-341x.1999.00580.x · Cited by 73 · see citing works
Bernstein, R. A., Lazzaro, V. D., Rymer, M. M., PASSMAN, R. S., Brachmann, J., Morillo, C. A., Sanna, T., Thijs, V., Rogers, T. B., Liu, S., et al. (2015) · Cerebrovascular Diseases · doi:10.1159/000437018 · Cited by 67 · see citing works
Self-citationA simple score for predicting paroxysmal atrial fibrillation in acute ischemic stroke
Fujii, S., Shibazaki, K., Kimura, K., Sakai, K., & Aoki, J. (2013) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2013.02.025 · Cited by 42 · see citing works
Does the STAF score help detect paroxysmal atrial fibrillation in acute stroke patients?
Horstmann, S., Rizos, T., Güntner, J., Hug, A., Jenetzky, E., Krumsdorf, U., & Veltkamp, R. C. (2012) · European Journal of Neurology · doi:10.1111/j.1468-1331.2012.03816.x · Cited by 37 · see citing works
Cotter, P. E., Martin, P. J., Pugh, P. J., Warburton, E. A., Cheriyan, J., & Belham, M. (2011) · Cerebrovascular Diseases Extra · doi:10.1159/000327346 · Cited by 34 · 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-citationNoseworthy, P. A., Kaufman, E. S., Chen, L. Y., Chung, M. K., Elkind, M. S. V., Joglar, J. A., Leal, M. A., McCabe, P. J., Pokorney, S. D., Yao, X., et al. (2019) · Circulation · doi:10.1161/cir.0000000000000740 · Cited by 171 · see citing works
- Authors
- Thijs, V. N., Brachmann, J., Morillo, C. A., Passman, R. S., Sanna, T., Bernstein, R. A., Diener, H.-C., Di Lazzaro, V., Rymer, M. M., Hogge, L., Rogers, T. B., Ziegler, P. D., & Assar, M. D.
- Affiliations
- Florey Institute of Neuroscience and Mental Health (AU)
- From the Florey Institute of Neuroscience and Mental Health and Austin Health Department of Neurology (V.N.T.), Heidelberg, Australia; Hospital Klinikum Coburg (J.B.), Teaching Hospital of the University of Würzburg, Coburg, Germany; Population Health Research Institute (C.A.M.), McMaster University, Hamilton, Canada; Northwestern University Feinberg School of Medicine (R.S.P.), Chicago, IL; Institute of Cardiology (T.S.), Catholic University of the Sacred Heart, Rome, Italy; Davee Department of...
- ORCID
- Venue
- Neurology
- Published
- 2016-01-19
- Volume
- 86
- Issue
- 3
- Pages
- 261-269
- ISSN
- 0028-3878 (ISSN-L)
- 1526-632X
- PMC
- PMC4733152
- OpenAlex
- W2215495516
- Cited by
- 170
- References
- 40
- Citations by year
- 2026: 4 · 2025: 10 · 2024: 14 · 2023: 20 · 2022: 22 · 2021: 23 · 2020: 17 · 2019: 14 · 2018: 15 · 2017: 14 · 2016: 17
- FWCI
- 11.14
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Neurology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Eli Lilly and Company
- Pfizer
- AstraZeneca
- GlaxoSmithKline
- Sanofi
- Boston Scientific Corporation
- European Commission
- Deutsche Forschungsgemeinschaft
- Bundesministerium für Bildung und Forschung
- Daiichi-Sankyo
- Servier
- H. Lundbeck A/S
- National Institutes of Health
- Allergan
- Bayer Vital
- Canadian Institutes of Health Research
- Biosense Webster
- Cilag
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cardiovascular and Diving-Related Complications
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Keywords
- atrial fibrillation, cryptogenic stroke, transient ischemic attack, implantable cardiac monitors, risk prediction, PR interval, age, CHADS2 score, premature atrial contractions, diabetes mellitus, patent foramen ovale
- MeSH terms
- Aged, Atrial Fibrillation, Ischemic Attack, Transient, Echocardiography, Electrocardiography, Female, Follow-Up Studies, Humans, Male, Middle Aged, Monitoring, Physiologic, Prognosis, Comorbidity, Randomized Controlled Trials as Topic, Stroke
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