Background and purpose: Published data suggest that patients with cerebral ischaemia and atrial fibrillation (CIAF) have higher in-hospital mortality than patients with cerebral ischaemia of arterial origin (CIAO). Data on long-term risks are scarce. We compared the long-term risks of death and vascular events (VE) between these groups.
Methods: We extended the follow-up of 2473 patients from the Dutch TIA Trial (recruitment 03/86-03/89, all treated with aspirin; CIAO) and 186 Dutch participants of the European Atrial Fibrillation Trial (recruitment 06/88-05/92, 26% on anticoagulants during the trial; CIAF). Hazard ratios (HRs) for death and VE of CIAF versus CIAO were analysed by means of Cox regression analysis and adjusted for age, sex and several cardiovascular risk factors.
Results: After a mean follow-up of 10.1 years, 1484 CIAO patients had died and 1336 had had at least one VE (377 cardiac, 455 stroke). The mean follow-up of the CIAF patients was 6.8 years: 150 patients had died and 136 had had at least one VE (41 cardiac, 63 stroke). Adjusted HRs (CIAF vs. CIAO) were 1.46 (95%CI 1.22-1.74) for death, 1.49 (1.24-1.79) for first VE, 1.94 (1.47-2.55) for first stroke and 1.41 (1.01-1.96) for first cardiac event. These HRs were essentially the same as those for the duration of the trials.
Conclusion: Our study shows that the long-term risk of death or vascular events is 1.5 times higher in CIAF patients than in those with CIAO after adjustment for differences between the groups.
- atrial fibrillation
- cerebral ischaemia
- long-term follow-up
- source of embolism