Implantable Cardiac Monitoring in the Secondary Prevention of Cryptogenic Stroke.
Aged
Anticoagulants
/ therapeutic use
Atrial Fibrillation
/ diagnosis
Cohort Studies
Early Diagnosis
Electrocardiography
/ instrumentation
Electrocardiography, Ambulatory
Female
Heart
/ physiopathology
Humans
Ischemic Attack, Transient
/ prevention & control
Ischemic Stroke
/ prevention & control
Male
Middle Aged
Outpatients
Prospective Studies
Prostheses and Implants
Recurrence
Secondary Prevention
/ methods
Treatment Outcome
Journal
Annals of neurology
ISSN: 1531-8249
Titre abrégé: Ann Neurol
Pays: United States
ID NLM: 7707449
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
received:
13
05
2020
revised:
17
08
2020
accepted:
17
08
2020
pubmed:
23
8
2020
medline:
15
12
2020
entrez:
23
8
2020
Statut:
ppublish
Résumé
In this study, we sought to evaluate the impact of implantable cardiac monitoring (ICM) in the prevention of stroke recurrence after a cryptogenic ischemic stroke or transient ischemic attack (TIA). We evaluated consecutive patients with cryptogenic ischemic stroke or TIA admitted in a comprehensive stroke center during an 8-year period. We compared the baseline characteristics and outcomes between patients receiving conventional cardiac monitoring with repeated 24-hour Holter-monitoring during the first 5 years in the outpatient setting and those receiving continuous cardiac monitoring with ICM during the last 3 years. Associations on the outcomes of interest were further assessed in multivariable regression models adjusting for potential confounders. We identified a total of 373 patients receiving conventional cardiac monitoring and 123 patients receiving ICM. Paroxysmal atrial fibrillation (PAF) detection was higher in the ICM cohort compared to the conventional cardiac monitoring cohort (21.1% vs 7.5%, p < 0.001). ICM was independently associated with an increased likelihood of PAF detection during follow-up (hazard ratio [HR] = 1.94, 95% confidence interval [CI] = 1.16-3.24) in multivariable analyses. Patients receiving ICM were also found to have significantly higher rates of anticoagulation initiation (18.7% vs 6.4%, p < 0.001) and lower risk of stroke recurrence (4.1% vs 11.8%, p = 0.013). ICM was independently associated with a lower risk of stroke recurrence during follow-up (HR = 0.32, 95% CI = 0.11-0.90) in multivariable analyses. ICM appears to be independently associated with a higher likelihood of PAF detection and anticoagulation initiation after a cryptogenic ischemic stroke or TIA. ICM was also independently related to lower risk of stroke recurrence in our cryptogenic stroke / TIA cohort. ANN NEUROL 2020;88:946-955.
Substances chimiques
Anticoagulants
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
946-955Informations de copyright
© 2020 American Neurological Association.
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