Temporal patterns, incidence, and predictors of early stroke recurrence in atrial fibrillation.

IF 4.5 3区医学 Q1 CLINICAL NEUROLOGY

European Stroke Journal Pub Date : 2025-07-01 DOI:10.1177/23969873251352397

Daniel Guisado-Alonso, Elisa Cuadrado-Godia, Ana Rodriguez-Campello, Isabel Fernández-Pérez, Adrià Macias-Gómez, Marta Vallverdú-Prats, Julia Peris-Subiza, Sergio Vidal-Notari, Laia Peraferrer-Montesinos, Jordi Jiménez-Conde, Joan Jiménez-Balado, Eva Giralt-Steinhauer, Angel Ois

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引用次数: 0

Abstract

Introduction: Early recurrence (ER) after an acute stroke event (ASE; ischemic or hemorrhagic) in patients with atrial fibrillation (AF) presents a therapeutic challenge due to the need to balance ischemic prevention with hemorrhagic risk. This study aimed to quantify ER incidence, both ischemic and hemorrhagic, and identify its predictors using real-world data from a prospective registry.

Patients and methods: Retrospective analysis of patients with AF, either known or detected within 6 months, who were admitted for a first-ever ASE to a tertiary stroke center between 2005 and 2024. ER was defined as any recurrent event within 6 months. Baseline characteristics, CHA₂DS₂-VASc score, CHADS-VA score, stroke severity, anticoagulation type, AF detection timing, and monitoring duration were recorded. Cox and Fine-Gray models identified independent predictors.

Results: Among 1795 patients, 108 (6.0%) experienced ER. The cumulative incidence was 6.3% (95% CI 5.1-7.4), and most events occurred within the first 30 days. Independent predictors included higher CHA₂DS₂-VASc score (sHR = 1.252, p = 0.023), lower initial stroke severity (sHR = 0.918, p < 0.001), concomitant stroke etiologies (sHR = 2.008, p = 0.001), and AF detected within 30 days after stroke (sHR = 1.644, p = 0.026). DOAC use was protective (sHR = 0.484, p = 0.003), while VKA showed a non-significant trend (sHR = 0.637, p = 0.068). Interaction analysis showed increased recurrence risk only in non-anticoagulated patients with AF detected after stroke. These findings were consistent across sensitivity analyses restricted to ischemic stroke, incorporating time-dependent anticoagulation, or comparing CHADS-VA and CHA₂DS₂-VASc scores.

Conclusions: ER, predominantly ischemic, occurred mainly within 30 days. Risk factors included AF detection timing, CHA₂DS₂-VASc score, stroke severity, concomitant causes, and anticoagulation status, supporting early risk stratification and DOAC initiation.

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心房颤动的时间模式、发病率和早期卒中复发的预测因素。

急性卒中事件（ASE）后早期复发（ER）；由于需要平衡缺血性预防和出血风险，房颤（AF）患者的缺血性或出血风险提出了一个治疗挑战。本研究旨在量化内窥镜的发生率，包括缺血性和出血性，并利用前瞻性登记的真实世界数据确定其预测因素。患者和方法：回顾性分析2005年至2024年三级卒中中心首次因急性房颤入院的6个月内已知或检测到的房颤患者。ER定义为6个月内的任何复发事件。记录基线特征、CHA2DS2-VASc评分、CHADS-VA评分、脑卒中严重程度、抗凝类型、AF检测时间、监测持续时间。Cox和Fine-Gray模型确定了独立的预测因子。结果：1795例患者中，108例（6.0%）发生了ER。累积发病率为6.3% (95% CI 5.1-7.4)，大多数事件发生在前30天。独立预测因子包括较高的CHA2DS2-VASc评分（sHR = 1.252, p = 0.023）、较低的卒中初始严重程度（sHR = 0.918, p p = 0.001）和卒中后30天内检测到AF （sHR = 1.644, p = 0.026）。DOAC的使用具有保护作用（sHR = 0.484, p = 0.003），而VKA的使用无统计学意义（sHR = 0.637, p = 0.068）。相互作用分析显示，仅在卒中后检测到房颤的非抗凝患者中复发风险增加。这些发现在限于缺血性卒中的敏感性分析中是一致的，包括时间依赖性抗凝，或比较CHADS-VA和CHA2DS2-VASc评分。结论：ER以缺血性为主，主要发生在30天内。危险因素包括房颤检测时间、CHA2DS2-VASc评分、卒中严重程度、伴发原因和抗凝状态，支持早期风险分层和DOAC启动。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Stroke Journal Multiple-

CiteScore

7.50

自引率

6.60%

发文量

102

期刊介绍： Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.