Ischemic Stroke in Patients With Sinus Node Disease, Atrial Fibrillation, and Other Cardiac Conditions

Frederic Sacher (1, 2) , Laurent Fauchier (3, 4) , Serge Boveda (5) , Christian de Chillou (6) , Pascal Defaye (7) , Jean Claude Deharo (8, 3) , Estelle Gandjbakhch (9) , Vincent Probst (10) , Ariel Cohen (11) , Christophe Leclercq (12) , Arnaud Bisson (13, 4) , Alexandre Bodin (13, 4, 14) , Julien Herbert (15) , Thibaud Lacour (15) , Christophe Saint Etienne (15) , Bertrand Pierre (16) , Nicolas Clementy (13, 4, 17) , Pierre Deharo (8, 3) , Dominique Babuty (13, 4) , Christophe Gaborit (18) , Gregory Y.H. Lip (19, 20, 21)

1 CRCTB - Centre de recherche Cardio-Thoracique de Bordeaux [Bordeaux]
2 CHU Bordeaux
3 Département de Cardiologie [Hôpital de la Timone - APHM]
4 EES - Éducation Éthique Santé EA 7505
5 Clinique Pasteur [Toulouse]
6 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
7 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
8 C2VN - Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research
9 CHU Pitié-Salpêtrière [AP-HP]
10 ITX - ITX - unité de recherche de l'institut du thorax
11 CHU Saint-Antoine [AP-HP]
12 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
13 CHU Trousseau [APHP]
14 PRC - Physiologie de la reproduction et des comportements [Nouzilly]
15 CHU Trousseau [Tours]
16 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
17 T2i - Transplantation, Immunologie, Inflammation [Tours]
18 Service d'Information Médicale d'Epidemiologie et d'Economie de la Santé
19 University of Liverpool
20 Liverpool Heart & Chest Hospital
21 AAU - Aalborg University [Denmark]

Background and Purpose— Atrial fibrillation (AF) is known to increase risk of ischemic stroke (IS), but the risk of IS in isolated sinus node disease (SND) is unclear. We compared the incidence of IS in patients with SND, patients with AF, and in a control population with other cardiac diseases (disease of the circulatory system using the International Classification of Diseases, Tenth Revision ). Methods— This French longitudinal cohort study was based on the national database covering hospital care for the entire population from 2008 to 2015. Results— Of 1 692 157 patients included in the cohort, 100 366 had isolated SND, 1 564 270 had isolated AF, and 27 521 had AF associated with SND. Incidence of IS during follow-up was higher in isolated patients with AF than in AF associated with SND (yearly rate 2.22% versus 2.06%) and in isolated patients with AF than in isolated patients with SND (yearly rate 2.22% versus 1.59%). The incidence of IS was lower in a control population with other cardiac conditions (n=479 108) compared with SND and patients with AF (0.96%/y, 1.59%/y, and 2.22%/y, respectively). After 1:1 propensity score matching, SND was associated with lower incidence of IS compared to AF (hazard ratio, 0.77 [95% CI, 0.73–0.82]) but higher incidence of IS compared to control population (hazard ratio, 1.27 [95%CI, 1.19–1.35]). Conclusions— Patients with SND had a lower risk of thromboembolic events than patients with AF but a higher risk than a control population with other cardiac diseases. Randomized clinical trial in a selected SND population, with, for example, a high CHA 2 DS 2 -VASc score, would be required to determine the value of IS prevention by anticoagulation.

Domaines: Sciences de l'Homme et Société

Frederic Sacher, Laurent Fauchier, Serge Boveda, Christian de Chillou, Pascal Defaye, et al.. Ischemic Stroke in Patients With Sinus Node Disease, Atrial Fibrillation, and Other Cardiac Conditions. Stroke, 2020, 51 (6), pp.1674-1681. ⟨10.1161/STROKEAHA.120.029048⟩. ⟨hal-03655991⟩