Prevalence and Prognostic Significance of Runs of Premature Atrial Complexes in Ischemic Stroke Patients.
OBJECTIVE
Runs of premature atrial complexes (PACs) are common in stroke patients and perceived to be clinically insignificant, but their prognostic significance is unclear. This study investigated the association between runs of PACs in ischemic stroke patients and the risk of recurrent ischemic strokes/transient ischemic attacks (TIAs) or death.


METHODS
The study included consecutive patients admitted with an ischemic stroke from August 2008 to April 2011. Patients with known and newly detected atrial fibrillation were excluded. Runs of PACs were defined as 3 or more PACs lasting less than 30 seconds during 48 hours of continuous inpatient cardiac telemetry. The patients were followed for 4 years or until death, whichever came first. They were stratified according to stroke severity. The combined primary endpoint was a recurrent ischemic stroke/TIA or death.


RESULTS
Of the 565 patients included in the study, 28% had runs of PACs. Patients with runs of PACs were likely to be older, female, and to have experienced more severe strokes. During the follow-up, 210 (37%) patients had a recurrent ischemic stroke/TIA (n = 73) or died (n = 137) respectively. Among the 489 patients who had mild-to-moderate strokes, runs of PACs were associated with recurrent ischemic strokes/TIAs or death (hazard ratio = 1.47; 95% CI 1.06-2.04; P = .023).


CONCLUSIONS
Runs of PACs were frequent in patients with acute ischemic strokes and sinus rhythm, and they were independently associated with an increased risk of recurrent ischemic strokes/TIAs or death in patients with mild-to-moderate strokes.
Department of Medical Research, OUH Svendborg Hospital, Svendborg, Denmark. Electronic address: kristinahoeg@hotmail.com.
Kristina H
KH
Vinther
Department of Internal Medicine, OUH Svendborg Hospital, Svendborg, Denmark.
Claus
C
Tveskov
OPEN-Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
Sören
S
Möller
Department of Internal Medicine, OUH Svendborg Hospital, Svendborg, Denmark.
Thomas
T
Rosen
Department of Internal Medicine, OUH Svendborg Hospital, Svendborg, Denmark.
Soren
S
Auscher
Department of Medical Research, OUH Svendborg Hospital, Svendborg, Denmark.
Armin
A
Osmanagic
Department of Medical Research, OUH Svendborg Hospital, Svendborg, Denmark.
Kenneth
K
Egstrup
D000368:Aged; D000369:Aged, 80 and over; D018880:Atrial Premature Complexes / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D013997:Time Factors
Atrial fibrillation; cardiac monitoring; ischemic stroke; premature atrial complexes; prognosis