Features of cardioembolic stroke with persistent and paroxysmal atrial fibrillation - a study with the Japan Stroke Registry.

Background and purpose The stroke severity on admission and clinical outcomes were compared between ischaemic stroke patients with non-valvular atrial fibrillation ( NVAF) of the persistent (Pe AF) and paroxysmal ( PAF) types. Methods The study comprised 9293 patients with cardioembolic stroke and NVAF who were registered in the Japanese stroke databank: 6522 had Pe AF (70.2%) and 2771 had PAF (29.8%). Stroke severity on admission and the clinical outcomes on discharge were retrospectively compared between these patient groups. Results The National Institutes of Health Stroke Scale score on admission (median, interquartile range) was 10 (3-20) for Pe AF patients and 7 (2-17) for PAF patients, indicating that stroke severity on admission was significantly worse in Pe AF patients than PAF patients ( P < 0.001). Good outcomes (modified Rankin scale score ≤2) were achieved by 45% Pe AF patients and 53% PAF patients. Thus, Pe AF patients had significantly poorer clinical outcomes than PAF patients ( P < 0.001). In-hospital mortality was significantly higher amongst Pe AF patients (11%) than PAF patients (8%) ( P < 0.001). Multivariate analysis of factors contributing to clinical outcomes showed that Pe AF was a contributing factor for in-hospital mortality (odds ratio 1.261; 95% confidence interval 1.011-1.652; P = 0.045). Conclusions Amongst cardioembolic stroke patients with NVAF, those with Pe AF have significantly higher stroke severity on admission than those with PAF, and Pe AF is a factor contributing to in-hospital mortality. Thus, our study suggests that the type of atrial fibrillation affects stroke severity and clinical outcomes following cerebral infarction. [ABSTRACT FROM AUTHOR]