Early and long-term risk of new-onset atrial fibrillation after transient ischemic attack

Abstract

Background: Transient ischemic attack (TIA) provides a unique opportunity to optimize secondary preventive treatments to avoid subsequent ischemic stroke (IS). Although atrial fibrillation (AF) is the leading cause of cardioembolism in IS and anticoagulation prevents stroke recurrence (SR), limited data exists about the risk of new-onset AF after TIA. Methods: We carried out a prospective cohort study of consecutive patients with TIA from January 2006 to June 2010. The risk of new diagnosis of AF and SR was defined after a median follow-up time of 6.5 (5.0-9.6) years. In a subgroup of consecutive patients, a panel of biomarkers was assessed during the first 24 h of the onset of symptoms. Results: 723 TIA patients were included. New-onset AF was diagnosed in 116 (16.0%) patients, 42 (36.2%) of them during admission. 204 (28.2%) patients were included in the biomarker substudy. New-onset AF was associated with sex (female) (hazard ratio [HR] 1.61 [95% CI, 1.07- 2.41]), age (HR 1.05 [95% CI, 1.03-1.07]), previous ischemic heart disease (HR 1.84 [95% CI 1.15-2.97]) and cortical DWI pattern (HR 2.81 [95% CI 1.87-4.21]). In the Kaplan-Meier analysis, NT-proBNP ≥218.2 pg/ml (log-rank test P<0.001) was associated with significant risk of new-onset AF during the first five years of follow-up. Patients with a new diagnosis of AF after admission and before five years of follow-up had the highest risk of SR (P=0.002). Conclusion: The risk of new diagnosis of AF after TIA is clinically relevant. We identified clinical, neuroimaging and biomarker predictors of new-onset AF.

Baseline characteristics and outcome of stroke patients after endovascular therapy according to previous symptomatic vascular disease and sex

“…Past studies have uncovered significant sex differences in vascular risk factor profiles. These studies have also identified the impact of specific vascular risk factors such as atrial fibrillation, diabetes mellitus, and arterial hypertension in women (7,8). Women have been reported to develop AIS at an older age compared to men (7,8).…”

“…These studies have also identified the impact of specific vascular risk factors such as atrial fibrillation, diabetes mellitus, and arterial hypertension in women (7,8). Women have been reported to develop AIS at an older age compared to men (7,8). Furthermore, they are less likely to receive intravenous thrombolysis (IVT) (9), and tend to experience more severe AIS with worse outcomes and higher mortality rates (8,10,11).…”