Atrial fibrillation as a predictive factor for severe stroke and early death in 15 831 patients with acute ischaemic stroke

• Published in: Journal of neurology, neurosurgery and psychiatry Vol. 76; no. 5; pp. 679 - 683
• Main Authors: Kimura, K, Minematsu, K, Yamaguchi, T
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01.05.2005; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; atrial fibrillation; Atrial Fibrillation - diagnosis; Atrial Fibrillation - rehabilitation; Biological and medical sciences; Blood. Blood coagulation. Reticuloendothelial system; Brain Ischemia - diagnosis; Brain Ischemia - mortality; Brain Ischemia - rehabilitation; Cardiac arrhythmia; confidence interval; ECG; Electrocardiography; Female; Health risk assessment; Hospitalization; Humans; J-MUSIC; Japan Multicenter Stroke Investigators’ Collaboration; Length of Stay; Male; Medical sciences; Middle Aged; modified Rankin scale; Mortality; mRS; National Institutes of Health Stroke Scale; Neurology; NIHSS; odds ratio; Pharmacology. Drug treatments; Risk Factors; Severity of Illness Index; Studies; Survival Rate; TIA; transient ischaemic attack; Vascular diseases and vascular malformations of the nervous system; Japan; Human; Stroke; Nervous system diseases; Arrhythmia; Atrial fibrillation; Cardiovascular disease; Excitability disorder; Cerebral disorder; Vascular disease; Ischemia; Heart disease; Central nervous system disease; Predictive factor; Cerebrovascular disease
• ISSN: 0022-3050; 1468-330X
• DOI: 10.1136/jnnp.2004.048827

Background: Atrial fibrillation (AF) is a common arrhythmia and a major risk factor for stroke. Aims: To assess whether AF in patients with acute ischaemic stroke is associated with severe stroke and early death. Materials/methods: Patients with acute ischaemic stroke (15 831) who were registered in the Japan Multicenter Stroke Investigators’ Collaboration registry were analysed. The AF group comprised 3335 (21.1%) patients (median age, 75 years) and the non-AF group comprised 12 496 (78.9%) patients (median age, 70 years). The association between AF and severe stroke and early death was investigated by means of multivariate logistic regression analysis. Results: The admission National Institutes of Health Stroke Scale (NIHSS) score of the AF group was higher than that of the non-AF group (median, 12 v 5; p < 0.0001). Multivariate logistic regression analyses found that female sex, advanced age, AF, and a history of stroke were independent factors associated with severe stroke (NIHSS score, ⩾ 11). The mortality rate within 28 days after admission was 11.3% in the AF group and 3.4% in the non-AF group (p < 0.0001). Multivariate logistic regression analyses identified older age, AF, and NIHSS score at admission as independent factors associated with early death. Conclusion: AF was a predictive factor for severe stroke and early death in acute ischaemic stroke. Careful cardiac evaluation and appropriate treatment are needed to improve outcome in patients with acute stroke and AF.