Newly Diagnosed Atrial Fibrillation After Transient Ischemic Attack Versus Minor Ischemic Stroke in the POINT Trial

BACKGROUND: Atrial fibrillation/flutter (AF) after transient ischemic attack (TIA) has not been well studied. We compared the likelihood of new AF diagnosis after ischemic stroke versus TIA. METHODS AND RESULTS: The POINT (Platelet‐Oriented Inhibition in New TIA and Minor Ischemic Stroke) trial enro...

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Autores principales: Kamel, Hooman, Farrant, Mary, Easton, J. Donald, Sposato, Luciano A., Elm, Jordan J., Underwood, Ellen, Johnston, S. Claiborne
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8174230/
https://www.ncbi.nlm.nih.gov/pubmed/33682440
http://dx.doi.org/10.1161/JAHA.120.019362
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author Kamel, Hooman
Farrant, Mary
Easton, J. Donald
Sposato, Luciano A.
Elm, Jordan J.
Underwood, Ellen
Johnston, S. Claiborne
author_facet Kamel, Hooman
Farrant, Mary
Easton, J. Donald
Sposato, Luciano A.
Elm, Jordan J.
Underwood, Ellen
Johnston, S. Claiborne
author_sort Kamel, Hooman
collection PubMed
description BACKGROUND: Atrial fibrillation/flutter (AF) after transient ischemic attack (TIA) has not been well studied. We compared the likelihood of new AF diagnosis after ischemic stroke versus TIA. METHODS AND RESULTS: The POINT (Platelet‐Oriented Inhibition in New TIA and Minor Ischemic Stroke) trial enrolled adults within 12 hours of minor ischemic stroke or high‐risk TIA. Our exposure was index event type (ischemic stroke versus TIA). The primary analysis used the original trial definition of TIA (resolution of symptoms/signs). In secondary analyses, TIA cases with infarction on neuroimaging were reclassified as strokes. Our primary outcome was a new AF diagnosis, ascertained from adverse event and treatment interruption/discontinuation reports. We calculated C‐statistics for variables associated with newly diagnosed AF. We used Kaplan‐Meier survival statistics and Cox models adjusted for demographics and vascular risk factors. Excluding 49 subjects with baseline AF, 2746 patients had index stroke and 2086 patients had index TIA. During the 90‐day follow‐up, 106 patients had newly diagnosed AF. Cumulative risks of AF were 2.7% (95% CI, 2.1%–3.4%) after stroke and 2.0% (95% CI, 1.5%–2.7%) after TIA (P=0.15). After reclassifying index events by neuroimaging, cumulative AF risk was higher after stroke (2.7%; 95% CI, 2.2%–3.4%) than TIA (1.8%; 95% CI, 1.3%–2.5%) (P=0.04). Index event type had negligible predictive utility (C‐statistic, 0.54). CONCLUSIONS: Among patients with cerebral ischemia, the distinction between TIA versus minor stroke did not stratify the risk of subsequent AF diagnosis, implying that patients with TIA should undergo similar heart‐rhythm monitoring strategies as patients with ischemic stroke.
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spelling pubmed-81742302021-06-11 Newly Diagnosed Atrial Fibrillation After Transient Ischemic Attack Versus Minor Ischemic Stroke in the POINT Trial Kamel, Hooman Farrant, Mary Easton, J. Donald Sposato, Luciano A. Elm, Jordan J. Underwood, Ellen Johnston, S. Claiborne J Am Heart Assoc Original Research BACKGROUND: Atrial fibrillation/flutter (AF) after transient ischemic attack (TIA) has not been well studied. We compared the likelihood of new AF diagnosis after ischemic stroke versus TIA. METHODS AND RESULTS: The POINT (Platelet‐Oriented Inhibition in New TIA and Minor Ischemic Stroke) trial enrolled adults within 12 hours of minor ischemic stroke or high‐risk TIA. Our exposure was index event type (ischemic stroke versus TIA). The primary analysis used the original trial definition of TIA (resolution of symptoms/signs). In secondary analyses, TIA cases with infarction on neuroimaging were reclassified as strokes. Our primary outcome was a new AF diagnosis, ascertained from adverse event and treatment interruption/discontinuation reports. We calculated C‐statistics for variables associated with newly diagnosed AF. We used Kaplan‐Meier survival statistics and Cox models adjusted for demographics and vascular risk factors. Excluding 49 subjects with baseline AF, 2746 patients had index stroke and 2086 patients had index TIA. During the 90‐day follow‐up, 106 patients had newly diagnosed AF. Cumulative risks of AF were 2.7% (95% CI, 2.1%–3.4%) after stroke and 2.0% (95% CI, 1.5%–2.7%) after TIA (P=0.15). After reclassifying index events by neuroimaging, cumulative AF risk was higher after stroke (2.7%; 95% CI, 2.2%–3.4%) than TIA (1.8%; 95% CI, 1.3%–2.5%) (P=0.04). Index event type had negligible predictive utility (C‐statistic, 0.54). CONCLUSIONS: Among patients with cerebral ischemia, the distinction between TIA versus minor stroke did not stratify the risk of subsequent AF diagnosis, implying that patients with TIA should undergo similar heart‐rhythm monitoring strategies as patients with ischemic stroke. John Wiley and Sons Inc. 2021-03-08 /pmc/articles/PMC8174230/ /pubmed/33682440 http://dx.doi.org/10.1161/JAHA.120.019362 Text en © 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Research
Kamel, Hooman
Farrant, Mary
Easton, J. Donald
Sposato, Luciano A.
Elm, Jordan J.
Underwood, Ellen
Johnston, S. Claiborne
Newly Diagnosed Atrial Fibrillation After Transient Ischemic Attack Versus Minor Ischemic Stroke in the POINT Trial
title Newly Diagnosed Atrial Fibrillation After Transient Ischemic Attack Versus Minor Ischemic Stroke in the POINT Trial
title_full Newly Diagnosed Atrial Fibrillation After Transient Ischemic Attack Versus Minor Ischemic Stroke in the POINT Trial
title_fullStr Newly Diagnosed Atrial Fibrillation After Transient Ischemic Attack Versus Minor Ischemic Stroke in the POINT Trial
title_full_unstemmed Newly Diagnosed Atrial Fibrillation After Transient Ischemic Attack Versus Minor Ischemic Stroke in the POINT Trial
title_short Newly Diagnosed Atrial Fibrillation After Transient Ischemic Attack Versus Minor Ischemic Stroke in the POINT Trial
title_sort newly diagnosed atrial fibrillation after transient ischemic attack versus minor ischemic stroke in the point trial
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8174230/
https://www.ncbi.nlm.nih.gov/pubmed/33682440
http://dx.doi.org/10.1161/JAHA.120.019362
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