Abstract 207: Infarct Topography and Detection of Atrial Fibrillation in Cryptogenic Stroke: The CRYSTAL-AF Study
Introduction: The Cryptogenic Stroke and Underlying Atrial Fibrillation (CRYSTAL AF) trial showed that continuous cardiac monitoring with an insertable cardiac monitor (ICM) detected atrial fibrillation (AF) in patients (pts) with cryptogenic ischemic stroke (CS) at a rate approximately 7 times greater than standard monitoring, with AF detection rates of 12.4% at one yearand 30.0% at three years in the ICM arm. We hypothesized that among the CS pts who underwent continuous monitoring there would be a radiographic pattern of infarction (acute and/or chronic) associated with an increased likelihood of subsequent AF detection by 12 months.
Methods: In this trial, 221 pts with recent CS confirmed by brain imaging were randomized to long-term continuous cardiac monitoring. The brain images, including 86 CT scans and 166 MRI scans, from 212 pts were available for review by a core lab to determine the distribution of acute and chronic lesions. Hazard ratios (HR) comparing pts with and without AF detected at 12 months were calculated for the imaging characteristics reviewed, and the log-rank test was used to determine significance.
Results: Index infarctions (pts could have >1 infarction as their index event) were cortical (41.6%); subcortical (18.1%); both cortical and subcortical (21.7%); lacunar (24.4%); posterior circulation (8.1%); and internal border zone (0.9%). Old ischemic infarctions were found in 106 pts (48.0%), including leukoaraiosis in 31.7%. No acute lesion pattern was significantly associated with AF detection at 12 months. However, detection of AF was more frequent in pts having chronic infarcts (HR 2.84 [95% CI 1.13-7.15], p=0.02), with territorial old infarctions (HR 2.37 [95% CI 0.98-5.72], p=0.05) or leukoaraiosis (HR 2.94 [95% CI 1.28-6.71], p <0.01) contributing most to increased AF detection.
Conclusions: In pts with CS who underwent continuous cardiac monitoring, no acute infarction pattern predicted detection of AF at 12 months. The presence of old infarcts was associated with detection of AF but the effect size was small. This suggests that long-term monitoring should be considered in all pts with CS as defined in CRYSTAL AF.
Author Disclosures: R.A. Bernstein: Speakers' Bureau; Significant; Medtronic, Boehringer Ingelheim, Bristol Myers Squibb/Pfizer. Consultant/Advisory Board; Modest; Bristol Myers Squibb/Pfizer. Consultant/Advisory Board; Significant; Medtronic, Boehringer Ingelheim. V. Di Lazzaro: Other Research Support; Modest; Medtronic. M.M. Rymer: Speakers' Bureau; Modest; Stryker, Inc, Covidien, Inc. R.S. Passman: Research Grant; Significant; Medtronic. Speakers' Bureau; Significant; Medtronic, Pfizer, Bristol Myers Squibb/Pfizer, Janssen. J. Brachmann: Research Grant; Significant; Medtronic. C.A. Morillo: Research Grant; Modest; Boston Scientific, Pfizer, Merck, Medtronic, CIHR, WHO, COLCIENCIAS. Speakers' Bureau; Modest; Boehringer Ingelheim, Boston Scientific, Merck, St. Jude. Consultant/Advisory Board; Modest; Boston Scientific, Boehringer Ingelheim. T. Sanna: Speakers' Bureau; Modest; Medtronic. Honoraria; Modest; Medtronic. T. Rogers: Employment; Significant; Medtronic. P.D. Ziegler: Employment; Significant; Medtronic. H. Diener: Other; Significant; Abbott, Allergan, AstraZeneca, Bayer Vital, BMS, Boehringer Ingelheim, CoAxia, Corimmun, Covidien, Daiichi-Sankyo, D-Pharm, Fresenius, GlaxoSmithKline, Janssen-Cilag, Johnson & Johnson, Knoll, Lilly,.
- © 2015 by American Heart Association, Inc.