Abstract 4145961: Assessing Short- and Long-Term Prognoses In Minor Stroke Patients With Nonvalvular Atrial Fibrillation

Introduction: Approximately 20% of ischemic strokes are linked to a cardioembolic source, with 80% of cardioembolic strokes being attributed to atrial fibrillation. This study aimed to investigate the impact of non-valvular atrial fibrillation (NVAF) on mortality and recurrent stroke following a minor stroke event, considering AF as the most prevalent sustained cardiac rhythm disorder associated with stroke. Methods and Materials: Consecutive patients experiencing minor acute ischemic stroke (NIHSS<5) underwent a thorough assessment, including transesophageal echocardiography and prolonged electrocardiography monitoring, before enrollment. Two subgroups were formed based on the diagnosis of NVAF. Clinical outcomes, encompassing all-cause mortality, cardiovascular death, recurrent ischemic stroke, and recurrent hemorrhagic stroke, were recorded. The association between NVAF and clinical outcomes was determined using Cox proportional hazards models. Results: Our study comprised a total of 6,190 patients, among whom 440 (7.1%) had NVAF, with a mean age of 63.4 years. In multivariate analyses, NVAF was associated with 12-month cardiovascular mortality (hazards ratio [HR] = 5.32, 95% CI 1.58 - 13.53). There was no discrepancy in the in-hospital ischemic stroke recurrence rate between the two groups (hazards ratio [HR] = 0.58, 95% CI 0.21 - 1.26). However, patients with NVAF exhibited a lower rate of recurrent ischemic stroke at medium- (3 months and 6 months) and long-term (12 months) follow-up (hazards ratio [HR] = 0.28, 95% CI, 0.19 - 0.74 at 3 months; 0.51, 95% CI 0.31–0.93 at 6 months; 0.62, 95% CI 0.29 - 0.90 at 12 months, respectively) compared to those without NVAF. Conclusion: In our study, patients with minor stroke and NVAF faced an elevated risk of cardiovascular death but experienced a reduced rate of recurrent ischemic stroke compared to those without NVAF over the following year post-stroke. This underscores the need for tailored guidelines for this patient cohort.