Atrial Fibrillation Detection and Ischemic Stroke Recurrence in Cryptogenic Stroke: A Retrospective, Multicenter, Observational Study

Todo, Kenichi; Okazaki, Shuhei; Doijiri, Ryosuke; Yamazaki, Hidekazu; Sonoda, Kazutaka; Koge, Junpei; Iwata, Tomonori; Ueno, Yuji; Yamagami, Hiroshi; Kimura, Naoto; Morimoto, Masafumi; Kondo, Daisuke; Koga, Masatoshi; Nagata, Eiichiro; Miyamoto, Nobukazu; Kimura, Yoko; Gon, Yasufumi; Sasaki, Tsutomu; Mochizuki, Hideki

doi:https://doi.org/10.1161/JAHA.123.031508

Atrial Fibrillation Detection and Ischemic Stroke Recurrence in Cryptogenic Stroke: A Retrospective, Multicenter, Observational Study

Todo, Kenichi; Okazaki, Shuhei; Doijiri, Ryosuke et al.

Journal of the American Heart Association, 2024, 13(3), e031508

Number of Access:2,224（2025-08-14 12:00 Counts）

Identifier to cite or link to this item: https://hdl.handle.net/11094/94881

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Title	Atrial Fibrillation Detection and Ischemic Stroke Recurrence in Cryptogenic Stroke: A Retrospective, Multicenter, Observational Study
Creator	NRID 1000040403068 1000040403068 researchmap permalink kenichitodo kenichitodo Scopus Author ID 22954718500 22954718500 CreatorName Todo, Kenichi
	NRID 1000060623072 1000060623072 researchmap permalink s-okazaki s-okazaki Scopus Author ID 16417354000 16417354000 CreatorName Okazaki, Shuhei
	CreatorName Doijiri, Ryosuke
	CreatorName Yamazaki, Hidekazu
	CreatorName Sonoda, Kazutaka
	CreatorName Koge, Junpei
	CreatorName Iwata, Tomonori
	NRID 1000000349002 1000000349002 CreatorName Ueno, Yuji
	NRID 1000000455552 1000000455552 CreatorName Yamagami, Hiroshi
	CreatorName Kimura, Naoto
	CreatorName Morimoto, Masafumi
	CreatorName Kondo, Daisuke
	NRID 1000030512230 1000030512230 CreatorName Koga, Masatoshi
	NRID 1000000255457 1000000255457 CreatorName Nagata, Eiichiro
	NRID 1000010365661 1000010365661 CreatorName Miyamoto, Nobukazu
	CreatorName Kimura, Yoko
	NRID 1000070751311 1000070751311 researchmap permalink y-gon y-gon Scopus Author ID 56565092900 56565092900 CreatorName Gon, Yasufumi
	NRID 1000020534879 1000020534879 ORCID 0000-0001-8726-978X 0000-0001-8726-978X researchmap permalink tsutomusasaki1111 tsutomusasaki1111 Scopus Author ID 7407394272 7407394272 CreatorName Sasaki, Tsutomu
	NRID 1000090230044 1000090230044 ORCID 0000-0002-0874-7542 0000-0002-0874-7542 researchmap permalink read0207787 read0207787 Scopus Author ID 7202006099 7202006099 CreatorName Mochizuki, Hideki
Subject	atrial fibrillation
	cryptogenic stroke
	ischemic stroke
Description	Todo K., Okazaki S., Doijiri R., et al. Atrial Fibrillation Detection and Ischemic Stroke Recurrence in Cryptogenic Stroke: A Retrospective, Multicenter, Observational Study. Journal of the American Heart Association 13, e031508 (2024); https://doi.org/10.1161/JAHA.123.031508.
Abstract	BACKGROUND: Atrial fibrillation (AF) is known to be a strong risk factor for stroke. However, the risk of stroke recurrence in patients with cryptogenic stroke with AF detected after stroke by an insertable cardiac monitor (ICM) is not well known. We sought to evaluate the risk of ischemic stroke recurrence in patients with cryptogenic stroke with and without ICM-detected AF. METHODS AND RESULTS: We retrospectively reviewed patients with cryptogenic stroke who underwent ICM implantation at 8 stroke centers in Japan. Cox regression models were developed using landmark analysis and time-dependent analysis. We set the target sample size at 300 patients based on our estimate of the annualized incidence of ischemic stroke recurrence to be 3% in patients without AF detection and 9% in patients with AF detection. Of the 370 patients, 121 were found to have AF, and 110 received anticoagulation therapy after AF detection. The incidence of ischemic stroke recurrence was 4.0% in 249 patients without AF detection and 5.8% in 121 patients with AF detection (P=0.45). In a landmark analysis, the risk of ischemic stroke recurrence was not higher in patients with AF detected ≤90 days than in those without (hazard ratio, 1.47 [95% CI, 0.41–5.28]). In a time-dependent analysis, the risk of ischemic stroke recurrence did not increase after AF detection (hazard ratio, 1.77 [95% CI, 0.70–4.47]). CONCLUSIONS: The risk of ischemic stroke recurrence in patients with cryptogenic stroke with ICM-detected AF, 90% of whom were subsequently anticoagulated, was not higher than in those without ICM-detected AF.
Publisher	American Heart Association Inc.
Source Title	Journal of the American Heart Association
Volume (Issue)	13(3)
Page	e031508
Date of Issued	2024-02-06
Language	English
Handle URL	https://hdl.handle.net/11094/94881
eISSN	20479980
Relation.isIdenticalTo	DOI (Publisher Version) https://doi.org/10.1161/JAHA.123.031508
Access Rights	open access
CopyRight	This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
oaire:version	Version of Record
Category	学術雑誌論文 Journal Article

Resource Type	journal article
Local Type	Journal Article
DCMI Type	Text
DCTERMS.bibliographicCitation	Journal of the American Heart Association. 2024, 13(3), p. e031508
DC.title	Atrial Fibrillation Detection and Ischemic Stroke Recurrence in Cryptogenic Stroke: A Retrospective, Multicenter, Observational Study
DC.creator	Todo, Kenichi
	Okazaki, Shuhei
	Doijiri, Ryosuke
	Yamazaki, Hidekazu
	Sonoda, Kazutaka
	Koge, Junpei
	Iwata, Tomonori
	Ueno, Yuji
	Yamagami, Hiroshi
	Kimura, Naoto
	Morimoto, Masafumi
	Kondo, Daisuke
	Koga, Masatoshi
	Nagata, Eiichiro
	Miyamoto, Nobukazu
	Kimura, Yoko
	Gon, Yasufumi
	Sasaki, Tsutomu
	Mochizuki, Hideki
DC.publisher	American Heart Association Inc.
DC.language' scheme='DCTERMS.RFC1766	English
DC.type' scheme='DCTERMS.DCMIType	Text
DCTERMS.issued' scheme='DCTERMS.W3CDTF	2024-02-06
DC.identifier	https://doi.org/10.1161/JAHA.123.031508
DC.subject	atrial fibrillation
	cryptogenic stroke
	ischemic stroke
DC.description	Todo K., Okazaki S., Doijiri R., et al. Atrial Fibrillation Detection and Ischemic Stroke Recurrence in Cryptogenic Stroke: A Retrospective, Multicenter, Observational Study. Journal of the American Heart Association 13, e031508 (2024); https://doi.org/10.1161/JAHA.123.031508.
DCTERMS.abstract	BACKGROUND: Atrial fibrillation (AF) is known to be a strong risk factor for stroke. However, the risk of stroke recurrence in patients with cryptogenic stroke with AF detected after stroke by an insertable cardiac monitor (ICM) is not well known. We sought to evaluate the risk of ischemic stroke recurrence in patients with cryptogenic stroke with and without ICM-detected AF. METHODS AND RESULTS: We retrospectively reviewed patients with cryptogenic stroke who underwent ICM implantation at 8 stroke centers in Japan. Cox regression models were developed using landmark analysis and time-dependent analysis. We set the target sample size at 300 patients based on our estimate of the annualized incidence of ischemic stroke recurrence to be 3% in patients without AF detection and 9% in patients with AF detection. Of the 370 patients, 121 were found to have AF, and 110 received anticoagulation therapy after AF detection. The incidence of ischemic stroke recurrence was 4.0% in 249 patients without AF detection and 5.8% in 121 patients with AF detection (P=0.45). In a landmark analysis, the risk of ischemic stroke recurrence was not higher in patients with AF detected ≤90 days than in those without (hazard ratio, 1.47 [95% CI, 0.41–5.28]). In a time-dependent analysis, the risk of ischemic stroke recurrence did not increase after AF detection (hazard ratio, 1.77 [95% CI, 0.70–4.47]). CONCLUSIONS: The risk of ischemic stroke recurrence in patients with cryptogenic stroke with ICM-detected AF, 90% of whom were subsequently anticoagulated, was not higher than in those without ICM-detected AF.
DC.rights	This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
DC.format	94881
citation_title	Atrial Fibrillation Detection and Ischemic Stroke Recurrence in Cryptogenic Stroke: A Retrospective, Multicenter, Observational Study
citation_author	Todo, Kenichi
	Okazaki, Shuhei
	Doijiri, Ryosuke
	Yamazaki, Hidekazu
	Sonoda, Kazutaka
	Koge, Junpei
	Iwata, Tomonori
	Ueno, Yuji
	Yamagami, Hiroshi
	Kimura, Naoto
	Morimoto, Masafumi
	Kondo, Daisuke
	Koga, Masatoshi
	Nagata, Eiichiro
	Miyamoto, Nobukazu
	Kimura, Yoko
	Gon, Yasufumi
	Sasaki, Tsutomu
	Mochizuki, Hideki
citation_publisher	American Heart Association Inc.
citation_language	English
citation_date	2024-02-06
citation_journal_title	Journal of the American Heart Association
citation_volume	13
citation_issue	3
citation_firstpage	e031508
citation_doi	https://doi.org/10.1161/JAHA.123.031508
citation_public_url	https://hdl.handle.net/11094/94881

Atrial Fibrillation Detection and Ischemic Stroke Recurrence in Cryptogenic Stroke: A Retrospective, Multicenter, Observational Study

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