Covert Brain Infarction as a Risk Factor for Stroke Recurrence in Patients With Atrial Fibrillation

Do Yeon Kim, Seok Gil Han, Han Gil Jeong, Keon Joo Lee, Beom Joon Kim, Moon Ku Han, Kang Ho Choi, Joon Tae Kim, Dong Ick Shin, Jae Kwan Cha, Dae Hyun Kim, Dong Eog Kim, Wi Sun Ryu, Jong Moo Park, Kyusik Kang, Jae Guk Kim, Soo Joo Lee, Mi Sun Oh, Kyung Ho Yu, Byung Chul LeeHong Kyun Park, Keun Sik Hong, Yong Jin Cho, Jay Chol Choi, Sung Il Sohn, Jeong Ho Hong, Tai Hwan Park, Kyung Bok Lee, Jee Hyun Kwon, Wook Joo Kim, Jun Lee, Ji Sung Lee, Juneyoung Lee, Philip B. Gorelick, Hee Joon Bae*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Background: We aimed to evaluate covert brain infarction (CBI), frequently encountered during the diagnostic work-up of acute ischemic stroke, as a risk factor for stroke recurrence in patients with atrial fibrillation (AF). Methods: For this prospective cohort study, from patients with acute ischemic stroke hospitalized at 14 centers between 2017 and 2019, we enrolled AF patients without history of stroke or transient ischemic attack and divided them into the CBI (+) and CBI (-) groups. The 2 groups were compared regarding the 1-year cumulative incidence of recurrent ischemic stroke and all-cause mortality using the Fine and Gray subdistribution hazard model with nonstroke death as a competing risk and the Cox frailty model, respectively. Each CBI lesion was also categorized into either embolic-appearing (EA) or non-EA pattern CBI. Adjusted hazard ratios and 95% CIs of any CBI, EA pattern CBI only, non-EA pattern CBI only, and both CBIs were estimated. Results: Among 1383 first-ever stroke patients with AF, 578 patients (41.8%) had CBI. Of these 578 with CBI, EA pattern CBI only, non-EA pattern CBI only, and both CBIs were 61.8% (n=357), 21.8% (n=126), and 16.4% (n=95), respectively. The estimated 1-year cumulative incidence of recurrent ischemic stroke was 5.2% and 1.9% in the CBI (+) and CBI (-) groups, respectively (P=0.001 by Gray test). CBI increased the risk of recurrent ischemic stroke (adjusted hazard ratio [95% CI], 2.91 [1.44-5.88]) but did not the risk of all-cause mortality (1.32 [0.97-1.80]). The EA pattern CBI only and both CBIs elevated the risk of recurrent ischemic stroke (2.76 [1.32-5.77] and 5.39 [2.25-12.91], respectively), while the non-EA pattern only did not (1.44 [0.40-5.16]). Conclusions: Our study suggests that AF patients with CBI might have increased risk of recurrent stroke. CBI could be considered when estimating the stroke risk in patients with AF.

Original languageEnglish (US)
Pages (from-to)87-95
Number of pages9
JournalStroke
Volume54
Issue number1
DOIs
StatePublished - Jan 1 2023

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

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