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. 2023 Sep;8(3):731-737.
doi: 10.1177/23969873231177625. Epub 2023 May 30.

The risk of stroke recurrence in patients with atrial fibrillation and reduced ejection fraction

RAF and RENO-EXTEND Investigators
Collaborators

The risk of stroke recurrence in patients with atrial fibrillation and reduced ejection fraction

RAF and RENO-EXTEND Investigators. Eur Stroke J. 2023 Sep.

Abstract

Background: Atrial fibrillation (AF) and congestive heart failure often coexist due to their shared risk factors leading to potential worse outcome, particularly cerebrovascular events. The aims of this study were to calculate the rates of ischemic and severe bleeding events in ischemic stroke patients having both AF and reduced ejection fraction (rEF) (⩽40%), compared to ischemic stroke patients with AF but without rEF.

Methods: We performed a retrospective analysis that drew data from prospective studies. The primary outcome was the composite of either ischemic (stroke or systemic embolism), or hemorrhagic events (symptomatic intracranial bleeding and severe extracranial bleeding).

Results: The cohort for this analysis comprised 3477 patients with ischemic stroke and AF, of which, 643 (18.3%) had also rEF. After a mean follow-up of 7.5 ± 9.1 months, 375 (10.8%) patients had 382 recorded outcome events, for an annual rate of 18.0%. While the number of primary outcome events in patients with rEF was 86 (13.4%), compared to 289 (10.2%) for the patients without rEF; on multivariable analysis rEF was not associated with the primary outcome (OR 1.25; 95% CI 0.84-1.88). At the end of follow-up, 321 (49.9%) patients with rEF were deceased or disabled (mRS ⩾3), compared with 1145 (40.4%) of those without rEF; on multivariable analysis, rEF was correlated with mortality or disability (OR 1.35; 95% CI 1.03-1.77).

Conclusions: In patients with ischemic stroke and AF, the presence of rEF was not associated with the composite outcome of ischemic or hemorrhagic events over short-term follow-up but was associated with increased mortality or disability.

Keywords: Acute stroke; atrial fibrillation; congestive heart failure.

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Conflict of interest statement

The author declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: M. Paciaroni received honoraria as a member of the speaker bureau of Sanofi-Aventis, Bayer, Bristol Meyer Squibb, Daiiki Sankyo and Pfizer.

Figures

Figure 1.
Figure 1.
Cumulative risk of combined, ischemic, or hemorrhagic endpoint events in patients with and without reduced ejection fraction.
Figure 2.
Figure 2.
Cumulative risk of combined endpoint events in patients with reduced ejection fraction treated with NOAC or with vitamin-K antagonist.
See this image and copyright information in PMC

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