Atrial fibrillation and stroke: clinical presentation of cardioembolic versus atherothrombotic infarction

The aim of the study was to compare demographic characteristics, anamnestic findings, cerebrovascular risk factors, and clinical and neuroimaging data of cardioembolic stroke patients with and without atrial fibrillation and of atherothrombotic stroke patients with and without atrial fibrillation. Predictors of early diagnosis of cardioembolic vs. atherothrombotic stroke infarction in atrial fibrillation patients were also determined. Data of cardioembolic stroke patients with (n=266) and without (n=81) atrial fibrillation and of atherothrombotic stroke patients with (n=75) and without (n=377) were obtained from 2000 consecutive patients included in the prospective Sagrat Cor-Alianza Hospital of Barcelona Stroke Registry. Risk factors, clinical characteristics and neuroimaging features in these subgroups were compared. The independent predictive value of each variable on early diagnosis of stroke subtype was assessed with a logistic regression analysis. In-hospital mortality in patients with atrial fibrillation was significantly higher than in non-atrial fibrillation patients both in cardioembolic (32.6% vs. 14.8%, P<0.005) and atherothrombotic stroke (29.3% vs. 18.8%, P<0.04). Valvular heart disease (odds ratio (OR) 4.6; 95% confidence interval (95% CI) 1.19–17.68) and sudden onset (OR 1.8; 95% CI 0.97–3.63) were predictors of cardioembolic stroke, and subacute onset (OR 8; 95% CI 1.29–49.42), COPD (OR 5.2; 95% CI 1.91–14.21), hypertension (OR 3.63; 95% CI 1.92–6.85), hypercholesterolemia (OR 2.67; 95% CI 1.13–6.28), transient ischaemic attack (OR 2.49; 95% CI 1.05–5.90), ischaemic heart disease (OR 2.30; 95% CI 1.15–4.60) and diabetes (OR 2.26; 95% CI 1.14–4.47) of atherothrombotic stroke. In conclusion, some clinical features at stroke onset may help clinicians to differentiate cerebral infarction subtypes in patients with atrial fibrillation. Atrial fibrillation is associated with a higher in-hospital mortality both in cardioembolic and atherothrombotic stroke patients.