Analysis of prognostic differences and risk factors in patients with atrial fibrillation known before ischemic stroke and atrial fibrillation diagnosed after ischemic stroke.
{"title":"Analysis of prognostic differences and risk factors in patients with atrial fibrillation known before ischemic stroke and atrial fibrillation diagnosed after ischemic stroke.","authors":"Dongjie Liu, Yan Zhao, Bingwei Zhang, Qi Lao, Lijia Wang, Xia Yi, Geng Chang","doi":"10.1007/s00415-025-13056-6","DOIUrl":null,"url":null,"abstract":"<p><strong>Aims: </strong>To compare the 1-year prognoses of patients with atrial fibrillation known before stroke (KAF) with those diagnosed after (AFDAS) and to explore the reasons for any observed differences.</p><p><strong>Methods: </strong>420 ischemic stroke patients were assigned to the KAF and AFDAS group. Follow-up information for both groups included the incidence of ischemic stroke recurrence, poor neurofunctional outcomes, and all-cause mortality within one year after the original ischemic stroke episode. The differences in the two groups' prognoses were assessed, and Cox/logistic regression models were employed to identify the underlying factors influencing this prognostic gap.</p><p><strong>Results: </strong>AFDAS had significantly lower rates of ischemic stroke recurrence (11.06% vs. 19.34%, P = 0.018) and poor neurofunctional outcome (25.48% vs. 36.79%, P = 0.012) compared to KAF. One-year all-cause mortality was similar between the two groups (7.69% vs. 9.91%, P = 0.424). AFDAS had a significantly lower risk of ischemic stroke recurrence even after adjusting for mortality factors (HR, 0.542; 95% CI, 0.325-0.903; P = 0.019). The incidence rate of ischemic stroke recurrence was significantly lower in AFDAS compared to KAF after adjustment for non-cardiac factors (HR, 0.561; 95% CI, 0.316-0.995; P = 0.042). However, there was no discernible difference in the two groups after adjustment for cardiac factors (HR, 0.659/0.588; 95% CI, 0.390-1.115/0.327-1.058; P = 0.120/0.077). The probability of a poor neurofunctional outcome was 3.758-fold higher in patients with recurrent ischemic stroke compared to those without recurrence (HR, 3.758; 95% CI, 1.587-8.900; P = 0.003). Compared to KAF, AFDAS was 88% less likely to have a poor neurofunctional outcome (HR, 0.120; 95% CI, 0.052-0.277; P < 0.001).</p><p><strong>Conclusion: </strong>Patients with AFDAS have a better prognosis than those with KAF.</p>","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 5","pages":"368"},"PeriodicalIF":4.8000,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Neurology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00415-025-13056-6","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Aims: To compare the 1-year prognoses of patients with atrial fibrillation known before stroke (KAF) with those diagnosed after (AFDAS) and to explore the reasons for any observed differences.
Methods: 420 ischemic stroke patients were assigned to the KAF and AFDAS group. Follow-up information for both groups included the incidence of ischemic stroke recurrence, poor neurofunctional outcomes, and all-cause mortality within one year after the original ischemic stroke episode. The differences in the two groups' prognoses were assessed, and Cox/logistic regression models were employed to identify the underlying factors influencing this prognostic gap.
Results: AFDAS had significantly lower rates of ischemic stroke recurrence (11.06% vs. 19.34%, P = 0.018) and poor neurofunctional outcome (25.48% vs. 36.79%, P = 0.012) compared to KAF. One-year all-cause mortality was similar between the two groups (7.69% vs. 9.91%, P = 0.424). AFDAS had a significantly lower risk of ischemic stroke recurrence even after adjusting for mortality factors (HR, 0.542; 95% CI, 0.325-0.903; P = 0.019). The incidence rate of ischemic stroke recurrence was significantly lower in AFDAS compared to KAF after adjustment for non-cardiac factors (HR, 0.561; 95% CI, 0.316-0.995; P = 0.042). However, there was no discernible difference in the two groups after adjustment for cardiac factors (HR, 0.659/0.588; 95% CI, 0.390-1.115/0.327-1.058; P = 0.120/0.077). The probability of a poor neurofunctional outcome was 3.758-fold higher in patients with recurrent ischemic stroke compared to those without recurrence (HR, 3.758; 95% CI, 1.587-8.900; P = 0.003). Compared to KAF, AFDAS was 88% less likely to have a poor neurofunctional outcome (HR, 0.120; 95% CI, 0.052-0.277; P < 0.001).
Conclusion: Patients with AFDAS have a better prognosis than those with KAF.
期刊介绍:
The Journal of Neurology is an international peer-reviewed journal which provides a source for publishing original communications and reviews on clinical neurology covering the whole field.
In addition, Letters to the Editors serve as a forum for clinical cases and the exchange of ideas which highlight important new findings. A section on Neurological progress serves to summarise the major findings in certain fields of neurology. Commentaries on new developments in clinical neuroscience, which may be commissioned or submitted, are published as editorials.
Every neurologist interested in the current diagnosis and treatment of neurological disorders needs access to the information contained in this valuable journal.