title: Stroke prevention in patients with non-valvular atrial fibrillation: new insight in selection of rhythm or rate control therapy and impact of mean platelet volume.
abstract: The aim of this study was to determine the impact of mean platelet volume (MPV) on the strategy for treatment of atrial fibrillation (AF) with respect to stroke prevention. MPV was analyzed in 265 patients with AF who were undergoing treatment using rhythm or rate control. The primary endpoint was ischemic stroke or a transient ischemic attack (TIA) event. Kaplan-Meier analysis revealed a significantly higher stroke rate in the rate control group compared to the rhythm control group. A significantly higher stroke rate was observed in the higher tertile MPV group (≥7.9 fL) compared to the lower tertile MPV group (<7.3 fL). When the MPV cut-off level was set to 7.85 fL using the receiver operating characteristic curve, the sensitivity was 80.0% and the specificity was 70.4% for differentiating between the group with stroke and the group without stroke. In the Cox proportional hazard analysis, after adjusting for sex, treatment strategy for AF, high MPV level, antithrombotic treatment, and high CHADS2 score, higher MPV, rate control strategy for treatment of AF, and high CHADS2 score were found to be independent predictors of stroke risk. In addition, patients with AF who were treated using rate control had high stroke risk with an MPV over 7.85 fL and high CHADS2 score. The results of this study demonstrate that the MPV and the rate control strategy for treatment of AF were predictive markers for stroke; its predictive power for stroke was independent of female sex and high CHADS2 score in patients with AF.
authors.affiliation: College of Medicine, Chosun University, 375 Seo-suk dong, Dong-Gu, Gwangju 501-759, Republic of Korea.
authors.forename: Soon-Pyo
authors.initials: SP
authors.lastname: Hong
authors.forename: Dong-Hyun
authors.initials: DH
authors.lastname: Choi
authors.forename: Hyun-Wook
authors.initials: HW
authors.lastname: Kim
authors.forename: Bo-Bae
authors.initials: BB
authors.lastname: Kim
authors.forename: Joong-Wha
authors.initials: JW
authors.lastname: Chung
authors.forename: Young-Youp
authors.initials: YY
authors.lastname: Koh
authors.forename: Kyong-Sig
authors.initials: KS
authors.lastname: Chang
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications* / Q000188:drug therapy; D002545:Brain Ischemia / Q000209:etiology / Q000517:prevention & control; D002317:Cardiovascular Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology / Q000517:prevention & control*; D053208:Kaplan-Meier Estimate; D008297:Male; D063847:Mean Platelet Volume; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012372:ROC Curve; D012680:Sensitivity and Specificity; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D002317:Cardiovascular Agents