J Korean Neurol Assoc.  1998 Dec;16(6):775-780.

Risk Factors of Cerebral Infarction in Patients with Atrial Fibrillation

• Park MS
• Lee SH
• Chung XK
• Kim MK
• Cho KH
• Kim SJ

Abstract

BACKGROUND: It is well known that atrial fibrillation is common cardiac arrythmia in old age and poses a definitive risk factor of cerebral infarction. Therefore, effective treatment of atrial fibrillation is very important in the prevention of cerebral infarction. However, oral anticoagulant medication for the prevention of embolic ischemic stroke may be dangerous due to cerebral hemorrhage side effects.
METHODS
This is a controlled case study designed to identify the risk factors in a large numbers of stroke and atrial fibrillation patients and to assess those patients with atrial fibrillation as a high risk group for cerebral infarction. All patient discharged from Chonnam National University Hospital were identified over a 42 month period who met our case standards of atrial fibrillation and ischemic stroke (n=62), and compared them with the control groups who were discharged with atrial fibrillation without stroke(n=68). We excluded the atrial fibrillation due to valvular heart disease, ischemic heart disease and congestive heart failure during the selection of subjects.
RESULTS
Subjects and the controls were characteristically similar with common past medical histories of diabets, smoking, and hyperlipidemia. Sex, familial history, left ventricular hypertrophy in 2D-echocardiogram were also similar in both groups, however differences did exist. Subjects were significantly older than controls(68.9 : 63.9, p<0.001) and more likely to have a history of hypertension(56.5% : 23.5%, p<0.001) and left atrial enlargement(>40mm)(52.6% : 29.0%, p<0.001). Each of these 3 factors were assinged a measure of 1 point as a risk score, ischemic embolic stroke was found in 4 out of 28 patients(14.3%) with a risk score of 0, in 16 out of 39 patients(41.0%) with a risk score of 1, in 29 out of 41 patients(70.7%) with a risk score of 2, in 8 out of 11 patients(72.7%) with a risk score of 3.
CONCLUSIONS
Based on the above results, a subject having more than two risk factors should be regarded as a high risk group for cerebral infarction and the long term anticoagulant therapy for the prevention of stroke may also be necessary even though some complications are present.

Keyword

Stroke with atrial fibrillation; Hypertension; Old age; Left atrial enlargement; Long term anticoagulation therapy

MeSH Terms

Arrhythmias, Cardiac
Atrial Fibrillation*
Cerebral Hemorrhage
Cerebral Infarction*
Heart Failure
Heart Valve Diseases
Humans
Hyperlipidemias
Hypertension
Hypertrophy, Left Ventricular
Jeollanam-do
Myocardial Ischemia
Patient Selection
Risk Factors*
Smoke
Smoking
Stroke
Smoke