Atrial fibrillation and stroke: clinical presentation of cardioembolic versus atherothrombotic infarction

The aim of the study was to compare demographic characteristics, anamnestic findings, cerebrovascular risk factors, and clinical and neuroimaging data of cardioembolic stroke patients with and without atrial fibrillation and of atherothrombotic stroke patients with and without atrial fibrillation. P redictors of early diagnosis of cardioembolic vs. atherothrombotic stroke i nfarction in atrial fibrillation patients were also determined. Data of car dioembolic stroke patients with (n=266) and without (n=81) atrial fibrillat ion and of atherothrombotic stroke patients with (n=75) and without (n=377) were obtained from 2000 consecutive patients included in the prospective S agrat Cor-Alianza Hospital of Barcelona Stroke Registry. Risk factors, clin ical characteristics and neuroimaging features in these subgroups were comp ared. The independent predictive value of each variable on early diagnosis of stroke subtype was assessed with a logistic regression analysis. In-hosp ital mortality in patients with atrial fibrillation was significantly highe r than in non-atrial fibrillation patients both in cardioembolic (32.6% vs. 14.8%, P<0.005) and atherothrombotic stroke (29.3% vs. 18.8%, P<0.04). Val vular heart disease (odds ratio (OR) 4.6; 95% confidence interval (95% CI) 1.19-17.68) and sudden onset (OR 1.8; 95% CI 0.97-3.63) were predictors of cardioembolic stroke, and subacute onset (OR 8; 95% CI 1.29-49.42), COPD (O R 5.2; 95% CI 1.91-14.21), hypertension (OR 3.63; 95% CI 1.92-6.85), hyperc holesterolemia (OR 2.67; 95% CI 1.13-6.28), transient ischaemic attack (OR 2.49; 95% CI 1.05-5.90), ischaemic heart disease (OR 2.30; 95% CI 1.15-4.60 ) and diabetes (OR 2.26; 95% CI 1.14-4.47) of atherothrombotic stroke. In c onclusion, some clinical features at stroke onset may help clinicians to di fferentiate cerebral infarction subtypes in patients with atrial fibrillati on. Atrial fibrillation is associated with a higher in-hospital mortality b oth in cardioembolic and atherothrombotic stroke patients. (C) 2000 Elsevie r Science Ireland Ltd. All rights reserved.