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  • Early ischaemic and haemorrhagic complications after atrial fibrillation-related ischaemic stroke: analysis of the IAC study

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Cerebrovascular disease
Original research
Early ischaemic and haemorrhagic complications after atrial fibrillation-related ischaemic stroke: analysis of the IAC study
  1. Shadi Yaghi1,
  2. Nils Henninger2,
  3. Erica Scher1,
  4. James Giles3,
  5. Angela Liu3,
  6. Muhammad Nagy2,
  7. Ashutosh Kaushal4,
  8. Idrees Azher4,5,
  9. Brian Mac Grory4,
  10. Hiba Fakhri6,
  11. Kiersten Brown Espaillat6,
  12. Syed Daniyal Asad7,
  13. Hemanth Pasupuleti8,
  14. Heather Martin8,
  15. Jose Tan8,
  16. Manivannan Veerasamy8,
  17. Ava L Liberman5,
  18. Charles Esenwa5,
  19. Natalie Cheng5,
  20. Khadean Moncrieffe5,
  21. Iman Moeini-Naghani9,
  22. Mithilesh Siddu9,
  23. Tushar Trivedi1,
  24. Christopher R Leon Guerrero9,
  25. Muhib Khan8,10,
  26. Amre Nouh7,
  27. Eva Mistry6,
  28. Salah Keyrouz3,
  29. Karen Furie4
  1. 1 Department of Neurology, NYU Langone Health, New York, New York, USA
  2. 2 Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  3. 3 Department of Neurology, Washington University in Saint Louis, St Louis, Missouri, USA
  4. 4 Department of Neurology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
  5. 5 Department of Neurology, Montefiore Hospital and Medical Center, Bronx, New York, USA
  6. 6 Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  7. 7 Department of Neurology, Hartford Hospital, Hartford, Connecticut, USA
  8. 8 Department of Neurology, Spectrum Health, Grand Rapids, Michigan, USA
  9. 9 Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
  10. 10 Department of Neurology, Michigan State University College of Human Medicine, East Lansing, Michigan, USA
  1. Correspondence to Dr Shadi Yaghi, Neurology, NYU Langone Health, New York, NY 10016, USA; shadiyaghi{at}yahoo.com

Abstract

Introduction Predictors of long-term ischaemic and haemorrhagic complications in atrial fibrillation (AF) have been studied, but there are limited data on predictors of early ischaemic and haemorrhagic complications after AF-associated ischaemic stroke. We sought to determine these predictors.

Methods The Initiation of Anticoagulation after Cardioembolic stroke study is a multicentre retrospective study across that pooled data from consecutive patients with ischaemic stroke in the setting of AF from stroke registries across eight comprehensive stroke centres in the USA. The coprimary outcomes were recurrent ischaemic event (stroke/TIA/systemic arterial embolism) and delayed symptomatic intracranial haemorrhage (d-sICH) within 90 days. We performed univariate analyses and Cox regression analyses including important predictors on univariate analyses to determine independent predictors of early ischaemic events (stroke/TIA/systemic embolism) and d-sICH.

Results Out of 2084 patients, 1520 patients qualified; 104 patients (6.8%) had recurrent ischaemic events and 23 patients (1.5%) had d-sICH within 90 days from the index event. In Cox regression models, factors associated with a trend for recurrent ischaemic events were prior stroke or transient ischemic attack (TIA) (HR 1.42, 95% CI 0.96 to 2.10) and ipsilateral arterial stenosis with 50%–99% narrowing (HR 1.54, 95% CI 0.98 to 2.43). Those associated with sICH were male sex (HR 2.68, 95% CI 1.06 to 6.83), history of hyperlipidaemia (HR 2.91, 95% CI 1.08 to 7.84) and early haemorrhagic transformation (HR 5.35, 95% CI 2.22 to 12.92).

Conclusion In patients with ischaemic stroke and AF, predictors of d-sICH are different than those of recurrent ischaemic events; therefore, recognising these predictors may help inform early stroke versus d-sICH prevention strategies.

https://doi.org/10.1136/jnnp-2020-323041

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    Footnotes

    • Twitter @neurogiles

    • Contributors SY: drafting manuscript, study concept and design, and data collection. NH, JG, ALL, EM, KF, CRLG, MK, AN and SK: study concept and design, site data management, and manuscript revision. ES and TT: Data management and manuscript revision. AL, MN, AK, IA, BMG, HF, KBE, SDA, HP, HM, JT, MV, CE, NC, KM, IM-N and MS: Data collection and manuscript revision.

    • Funding NH is supported by K08NS091499 from the National Institute of Neurological Disorders and Stroke of the National Institutes of Health and R44NS076272 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health. ALL is supported by K23NS107643 from the National Institute of Neurological Disorders and Stroke of the National Institutes of Health.

    • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

    • Competing interests SY’s department received funding from Medtronic for his work in outcome adjudication for the Stroke AF trial.

    • Patient consent for publication Not required.

    • Ethics approval Institutional Review Board approval was obtained from each of the participating centres.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on reasonable request. Data are available for sharing on email request to corresponding author.