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Published on: February 26, 2013
Predictors of Ischemic Stroke in Patients With Non-valvular Atrial Fibrillation: A Retrospective Study
Muhammad Waleed Jabbar1,2,3, Tayyaba Shabbir4,5, Saad Binliaquat4,5
1Internal Medicine, Kharkiv National Medical University, Kharkiv, UKR.
Insights
Ischemic stroke (IS) affects over 20% of non-valvular atrial fibrillation (AF) patients. Key predictors include advanced age, prior stroke, vascular disease, smoking, kidney disease, inadequate anticoagulation, left atrial enlargement, reduced ejection fraction, and left atrial appendage thrombus.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- Atrial fibrillation (AF) is a common arrhythmia and a significant risk factor for ischemic stroke (IS).
- The CHA₂DS₂-VASc score is standard for stroke risk stratification in AF patients.
- Additional factors beyond the CHA₂DS₂-VASc score may influence IS risk.
Purpose of the Study:
- To determine the incidence of IS in patients with non-valvular AF.
- To identify independent predictors of IS in this patient population.
Main Methods:
- Retrospective study of 350 non-valvular AF patients at a tertiary care hospital.
- Data collection included demographics, clinical factors, anticoagulation status, CHA₂DS₂-VASc scores, and echocardiographic findings.
- Statistical analysis involved t-tests, chi-square tests, and multivariable logistic regression.
Main Results:
- Ischemic stroke (IS) occurred in 20.28% of the study population.
- Patients with IS had significantly higher CHA₂DS₂-VASc scores (4.50 vs. 3.20).
- Independent predictors of IS included: age ≥65, prior stroke/TIA, vascular disease, smoking, chronic kidney disease, inadequate anticoagulation, left atrial enlargement, reduced left ventricular ejection fraction (LVEF<40%), and left atrial appendage (LAA) thrombus/spontaneous echo contrast (SEC).
Conclusions:
- A substantial proportion of non-valvular AF patients experienced IS.
- Several factors beyond the CHA₂DS₂-VASc score independently predict IS.
- Integrating these factors into risk assessment can improve stroke prevention strategies in AF patients.
Abstract:
Background Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and a major cause of ischemic stroke (IS). Although the Congestive heart failure (or left ventricular dysfunction), Hypertension, Age ≥ 75 years, Diabetes mellitus, prior Stroke, transient ischemic attack (TIA), or thromboembolism, Vascular disease (prior heart attack, peripheral artery disease, or aortic plaque), Age 65 to 74 years, and Sex category (Female) or CHA₂DS₂-VASc score is widely used for stroke risk stratification, additional clinical, treatment-related, and echocardiographic factors may influence stroke risk. This study aimed to determine the frequency of IS and identify its independent predictors among patients with non-valvular AF. Methods This retrospective study included 350 patients with non-valvular AF treated at a tertiary care hospital in Rawalpindi, Pakistan. Demographic, clinical, anticoagulation, CHA₂DS₂-VASc, and echocardiographic data were extracted from medical records. Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States). Group comparisons were conducted using the independent-samples t-test and chi-square test, followed by multivariable logistic regression to identify independent predictors of IS. Results From the total study population, 71 (20.28%) experienced IS. Patients with stroke had a significantly higher mean CHA₂DS₂-VASc score than those without stroke (4.50 ± 1.40 vs. 3.20 ± 1.20, p<0.001). On initial analysis, age ≥65 years, previous stroke/TIA, vascular disease, smoking, chronic kidney disease, inadequate anticoagulation, left atrial enlargement, reduced left ventricular ejection fraction (LVEF<40%), left atrial appendage (LAA) thrombus/spontaneous echo contrast (SEC), and CHA₂DS₂-VASc score ≥4 were significantly associated with IS (all p<0.05). Multivariable logistic regression confirmed age ≥65 years (adjusted odds ratio (AOR)=2.59; p=0.003), previous stroke/TIA (AOR=2.37; p=0.012), vascular disease (AOR=1.88; p=0.045), smoking (AOR=1.93; p=0.039), chronic kidney disease (AOR=2.12; p=0.028), inadequate anticoagulation (AOR=2.90; p=0.001), left atrial enlargement (AOR=2.32; p=0.007), reduced LVEF (AOR=1.94; p=0.042), and LAA thrombus/SEC (AOR=3.07; p=0.004) as independent predictors of IS. Conclusion IS was observed in a considerable proportion of patients with non-valvular AF. IS was independently associated with advanced age, previous stroke/TIA, vascular disease, smoking, chronic kidney disease, inadequate anticoagulation, left atrial enlargement, reduced LVEF, and LAA thrombus/SEC. Assessment of these factors, in addition to the CHA₂DS₂-VASc score, may enhance risk stratification and facilitate timely implementation of preventive strategies.
