title: Atrial Fibrillation Is Associated With a Worse 90-Day Outcome Than Other Cardioembolic Stroke Subtypes.
abstract: Patients with a cardioembolic stroke (CES) have worse outcomes than stroke patients with other causes of stroke. Among patients with CES, atrial fibrillation (AF) is a common comorbidity. Mounting data indicate that AF may be related to stroke pathogenesis beyond acute cerebral thromboembolism. We sought to determine whether AF represents an independent risk factor for stroke severity and outcome among patients with CES.
  
  
  
  We retrospectively analyzed patients with acute hemispheric CES included in an academic medical center's stroke registry. CES was determined using the Causative Classification System of ischemic stroke. Multivariable logistic regression was used to determine whether AF was associated with 90-day outcome functional status.
  
  
  
  Our cohort included 140 patients. Of these, 52 had prevalent AF and 28 had incident AF diagnosed during their index hospitalization or within 90 days of hospital discharge. After adjustment for potential confounders or mediators, any AF (odds ratio, 2.51; 95% confidence interval, 1.03-6.33; P=0.049), infarct volume (odds ratio, 1.03; 95% confidence interval, 1.01-1.06; P=0.005), preadmission modified Rankin Scale score (odds ratio, 2.58; 95% confidence interval, 1.66-4.01; P<0.001), and admission National Institutes of Health Stroke Scale score (odds ratio, 1.17; 95% confidence interval, 1.08-1.28; P<0.001) remained associated with an unfavorable 90-day outcome (modified Rankin Scale score, 2-6).
  
  
  
  AF is associated with an unfavorable 90-day outcome among patients with a CES independent of established risk factors and initial stroke severity. This suggests that AF-specific mechanisms affect CES severity and functional status after CES. If confirmed in future studies, further investigation into the underlying pathophysiological mechanisms may provide novel avenues to AF detection and treatment.
authors.affiliation: From the Departments of Neurology (N.H., R.P.G., J.H.), Psychiatry (N.H.), and Internal Medicine (A.K.) and Division of Cardiology, Department of Internal Medicine (D.D.M.), University of Massachusetts Medical School, Worcester. nils.henninger@umassmed.edu.
authors.forename: Nils
authors.initials: N
authors.lastname: Henninger
authors.affiliation: From the Departments of Neurology (N.H., R.P.G., J.H.), Psychiatry (N.H.), and Internal Medicine (A.K.) and Division of Cardiology, Department of Internal Medicine (D.D.M.), University of Massachusetts Medical School, Worcester.
authors.forename: Richard P
authors.initials: RP
authors.lastname: Goddeau
authors.affiliation: From the Departments of Neurology (N.H., R.P.G., J.H.), Psychiatry (N.H.), and Internal Medicine (A.K.) and Division of Cardiology, Department of Internal Medicine (D.D.M.), University of Massachusetts Medical School, Worcester.
authors.forename: Ameeta
authors.initials: A
authors.lastname: Karmarkar
authors.affiliation: From the Departments of Neurology (N.H., R.P.G., J.H.), Psychiatry (N.H.), and Internal Medicine (A.K.) and Division of Cardiology, Department of Internal Medicine (D.D.M.), University of Massachusetts Medical School, Worcester.
authors.forename: Johanna
authors.initials: J
authors.lastname: Helenius
authors.affiliation: From the Departments of Neurology (N.H., R.P.G., J.H.), Psychiatry (N.H.), and Internal Medicine (A.K.) and Division of Cardiology, Department of Internal Medicine (D.D.M.), University of Massachusetts Medical School, Worcester.
authors.forename: David D
authors.initials: DD
authors.lastname: McManus
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications* / Q000000981:diagnostic imaging; D002545:Brain Ischemia / Q000209:etiology / Q000628:therapy; D002544:Cerebral Infarction / Q000150:complications / Q000000981:diagnostic imaging; D015331:Cohort Studies; D038524:Diffusion Magnetic Resonance Imaging; D004617:Embolism / Q000150:complications*; D005260:Female; D006331:Heart Diseases / Q000150:complications*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: atrial fibrillation; cerebral infarction; classification; outcomes research; risk factors; stroke