Stroke: occult cerebral infarction is a risk factor for stroke recurrence in patients with atrial fibrillation

Occult cerebral infarction (CBI), as a risk factor for stroke recurrence in patients with atrial fibrillation, is often encountered in the diagnosis of acute ischemic stroke
.

In this prospective cohort study, researchers recruited patients with atrial fibrillation without a history of stroke or transient ischemic attack from 14 hospitalized acute ischemic stroke patient centers between 2017 and 2019 and divided them into CBI(+) and CBI(−) groups
.

The investigators compared the cumulative one-year incidence of ischemic stroke recurrence and all-cause mortality between the two groups, using the Fine and Gray subdistribution risk models and the Cox frailty model
with non-stroke death as a competitive risk, respectively.
Each CBI lesion is also classified as embolic (EA)CBI or non-EA CBI
.
Adjusted risk ratios and 95% CI were estimated
for any CBI, EA-only CBI, non-EA-only CBI, and both CBIs.

Of the 1383 stroke patients who developed atrial fibrillation for the first time, 578 (41.
8%) developed a CBI
.
Of the 578 patients with CBI, 61.
8% (n=357), 21.
8% (n=126), and 16.
4% (n=95) had EA-only CBI, EA-only CBI, and both
, respectively.
The cumulative one-year incidence of recurrent ischemic stroke in the CBI(+) and CBI(−) groups was 5.
2% and 1.
9%, respectively (Gray test P=0.
001).

CBI increased the risk of recurrent ischaemic stroke (adjusted hazard ratio [95% CI] 2.
91 [1.
44 to 5.
88]), but did not increase the risk of all-cause mortality (1.
32 [0.
97 to 1.
80]).

EA-only CBIs and both CBIs increased the risk of recurrent ischemic stroke (2.
76 [1.
32-5.
77] and 5.
39 [2.
25-12.
91], respectively), while non-EA-only (1.
44 [0.
40-5.
16]).

Thus, the results of the study suggest that atrial fibrillation with CBI may increase the risk of
stroke recurrence.
Occult cerebral infarction may be considered to estimate stroke risk
in patients with atrial fibrillation.

Original source:

Do Yeon Kim.
et al.
Covert Brain Infarction as a Risk Factor for Stroke Recurrence in Patients With Atrial Fibrillation.
stroke.
2022.