(Stroke. 1995;26:801-806.)
© 1995 American Heart Association, Inc.
Articles |
Predictors of Major Vascular Events in Patients With a Transient Ischemic Attack or Minor Ischemic Stroke and With Nonrheumatic Atrial Fibrillation
From the University Hospital Rotterdam Dijkzigt (Netherlands) (J.C. van L., P.J.K.); Royal Hallamshire Hospital, Sheffield, United Kingdom (G.S.V.); and University Hospital Utrecht (Netherlands) (J. van G., L.J.K., A.A.). Participating clinics for the EAFT have been listed elsewhere (Lancet. 1993;342:1255-1262).
Correspondence to Dr Peter J. Koudstaal, MD, Department of Neurology, University Hospital Rotterdam Dijkzigt, 40 Dr Molewaterplein, 3015 GD Rotterdam, Netherlands.
Background and Purpose The risk of major vascular events after an initial episode of cerebral ischemia in patients with nonrheumatic atrial fibrillation (NRAF) varies from 2% to 15% in the first year and is approximately 5% yearly thereafter. Few studies have reported on risk factors that can be used to identify high-risk subgroups within this patient population.
Methods We studied the predictive value of several easily obtainable clinical characteristics in a group of 375 placebo-treated patients with NRAF and a recent episode of transient or nondisabling cerebral ischemia who were entered in a multicenter clinical trial. The mean follow-up was 1.6 years.
Results By means of multivariate modeling, six independent variables were identified: history of previous thromboembolism, ischemic heart disease, enlarged cardiothoracic ratio on chest roentgenogram, systolic blood pressure greater than 160 mm Hg at study entry, NRAF for more than 1 year, and presence of an ischemic lesion on CT scan. These variables could also be used to stratify patients in low-, medium-, and high-risk subgroups for the other two arms of the trial, those treated with anticoagulation and aspirin. Patients older than 75 years with three or more risk factors seemingly benefited less from both aspirin and anticoagulant treatment.
Conclusions Easily obtainable patient characteristics are helpful in estimating the potential effect of adequate secondary prevention in patients with NRAF who recently suffered a transient ischemic attack or minor ischemic stroke.
Key Words: atrial fibrillation • cerebral ischemia, transient • risk factors • stroke prevention
This article has been cited by other articles:
 |
|
 |
|
  M. Hughes, G.Y.H. Lip, and on behalf of the Guideline Development Group for t Risk factors for anticoagulation-related bleeding complications in patients with atrial fibrillation: a systematic review QJM, October 1, 2007; 100(10): 599 - 607. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Writing Committee Members, V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society Europace, September 1, 2006; 8(9): 651 - 745. [Full Text] [PDF]
|
|
|
|
 |
|
 V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society J. Am. Coll. Cardiol., August 15, 2006; 48(4): e149 - e246. [Full Text] [PDF]
|
|
|
|
 |
|
 V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society Circulation, August 15, 2006; 114(7): e257 - e354. [Full Text] [PDF]
|
|
|
|
|
|
B. F. Gage, C. van Walraven, L. Pearce, R. G. Hart, P. J. Koudstaal, B.S.P. Boode, and P. Petersen Selecting Patients With Atrial Fibrillation for Anticoagulation: Stroke Risk Stratification in Patients Taking Aspirin Circulation, October 19, 2004; 110(16): 2287 - 2292. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. F. Gage, A. D. Waterman, W. Shannon, M. Boechler, M. W. Rich, and M. J. Radford Validation of Clinical Classification Schemes for Predicting Stroke: Results From the National Registry of Atrial Fibrillation JAMA, June 13, 2001; 285(22): 2864 - 2870. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Verstraete, C. R. M. Prentice, M. Samama, and R. Verhaeghe A European View on the North American Fifth Consensus on Antithrombotic Therapy Chest, June 1, 2000; 117(6): 1755 - 1770. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Cohen, D. Almoznino-Sarafian, I. Alon, O. Gorelik, M. Koopfer, S. Chachashvily, M. Shteinshnaider, V. Litvinjuk, and D. Modai Warfarin for Stroke Prevention Still Underused in Atrial Fibrillation : Patterns of Omission Stroke, June 1, 2000; 31(6): 1217 - 1222. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. L. Hart, D. J. Hole, and G. D. Smith Risk Factors and 20-Year Stroke Mortality in Men and Women in the Renfrew/Paisley Study in Scotland Stroke, October 1, 1999; 30(10): 1999 - 2007. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
The SPAF III Writing Committee for the Stroke Prev Patients With Nonvalvular Atrial Fibrillation at Low Risk of Stroke During Treatment With Aspirin: Stroke Prevention in Atrial Fibrillation III Study JAMA, April 22, 1998; 279(16): 1273 - 1277. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Sato, Y. Honda, H. Kunoh, and K. Oizumi Long-term Oral Anticoagulation Reduces Bone Mass in Patients with Previous Hemispheric Infarction and Nonrheumatic Atrial Fibrillation Stroke, December 1, 1997; 28(12): 2390 - 2394. [Abstract] [Full Text]
|
|