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Long-term occurrence of death and cardiovascular events in patients with TIA or minor ischaemic stroke: comparison between arterial and cardiac source of the index event
  1. I van Wijk (i.v.wijk{at}dehoogstraat.nl)
  1. Rehabilation Centre De Hoogstraat, Utrecht, Netherlands
    1. P J Koudstaal (p.j.koudstaal{at}erasmusmc.nl)
    1. Erasmus Medisch Centrum, Rotterdam, Netherlands
      1. L J Kappelle (l.kappelle{at}umcutrecht.nl)
      1. Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Netherlands
        1. J van Gijn (j.vangijn{at}neuro.azu.nl)
        1. Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Netherlands
          1. J W Gorter (j.w.gorter{at}dehoogstraat.nl)
          1. Rehabiliation Centre de Hoogstraat, Netherlands
            1. A Algra (a.algra{at}umcutrecht.nl)
            1. UMC Utrecht, Netherlands

              Abstract

              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

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