Atrial fibrillation as a predictive factor for severe stroke and early death in 15 831 patients with acute ischaemic stroke

Abstract

Background: Atrial fibrillation (AF) is a common arrhythmia and a major risk factor for stroke. Aims: To assess whether AF in patients with acute ischaemic stroke is associated with severe stroke and early death. Materials/methods: Patients with acute ischaemic stroke (15 831) who were registered in the Japan Multicenter Stroke Investigators’ Collaboration registry were analysed. The AF group comprised 3335 (21.1%) patients (median age, 75 years) and the non-AF group comprised 12 496 (78.9%) patients (median age, 70 years). The association between AF and severe stroke and early death was investigated by means of multivariate logistic regression analysis. Results: The admission National Institutes of Health Stroke Scale (NIHSS) score of the AF group was higher than that of the non-AF group (median, 12 v 5; p < 0.0001). Multivariate logistic regression analyses found that female sex, advanced age, AF, and a history of stroke were independent factors associated with severe stroke (NIHSS score, ⩾ 11). The mortality rate within 28 days after admission was 11.3% in the AF group and 3.4% in the non-AF group (p < 0.0001). Multivariate logistic regression analyses identified older age, AF, and NIHSS score at admission as independent factors associated with early death. Conclusion: AF was a predictive factor for severe stroke and early death in acute ischaemic stroke. Careful cardiac evaluation and appropriate treatment are needed to improve outcome in patients with acute stroke and AF.