Prolonged Cardiac Rhythm Monitoring and Secondary Stroke Prevention in Patients With Cryptogenic Cerebral Ischemia

Georgios Tsivgoulis, Aristeidis H. Katsanos, Brian Mac Grory, Martin Köhrmann, Brittany A. Ricci, Konstantinos Tsioufis, Shawna Cutting, Christos Krogias, Peter D. Schellinger, Ana Rodriguez Campello, Elisa Cuadrado-Godia, David J. Gladstone, Tommaso Sanna, Rolf Wachter, Karen Furie, Andrei V. Alexandrov, Shadi Yaghi

Research output: Contribution to journalArticle

Abstract

Background and Purpose- Although prolonged cardiac rhythm monitoring (PCM) can reveal a substantial proportion of ischemic stroke (IS) patients with atrial fibrillation not detected by conventional short-term monitoring, current guidelines indicate an uncertain clinical benefit for PCM. We evaluated the impact of PCM on secondary stroke prevention using data from available to date randomized clinical trials and observational studies. Methods- We performed a comprehensive literature search in MEDLINE, SCOPUS, CENTRAL (Cochrane Central Register of Controlled Trial), and conference proceedings to identify studies reporting stroke recurrence rates in patients with history of cryptogenic IS or transient ischemic attack (TIA) receiving PCM compared with patients receiving conventional (non-PCM) cardiac monitoring. Results- We included 4 studies (2 randomized clinical trials and 2 observational studies), including a total of 1102 patients (mean age: 68 years, 41% women). We documented an increased incidence of atrial fibrillation detection (risk ratio=2.46; 95% CI, 1.61-3.76) and anticoagulant initiation (risk ratio=2.07; 95% CI, 1.36-3.17) and decreased risk of recurrent stroke (risk ratio=0.45; 95% CI, 0.21-0.97) and recurrent stroke/TIA (risk ratio=0.49; 95% CI, 0.30-0.81) during follow-up for IS/TIA patients who underwent PCM compared with IS/TIA patients receiving conventional cardiac monitoring. In the subgroup analysis, according to study type, atrial fibrillation detection, anticoagulant initiation, and IS/TIA recurrence rates were comparable between PCM and non-PCM in randomized clinical trials and observational studies. No evidence of heterogeneity (I2<12%) was documented across all the aforementioned subgroups. Conclusions- We provide preliminary evidence for a potential impact of PCM on secondary stroke prevention, as patients with cryptogenic IS/TIA undergoing PCM had higher rates of atrial fibrillation detection, anticoagulant initiation, and lower stroke recurrence.

Original languageEnglish (US)
Pages (from-to)2175-2180
Number of pages6
JournalStroke
Volume50
Issue number8
DOIs
StatePublished - Aug 1 2019

Fingerprint

Secondary Prevention
Brain Ischemia
Anticoagulants
Atrial Fibrillation
Stroke
Recurrence
Transient Ischemic Attack
Incidence
Odds Ratio
Observational Studies
Randomized Controlled Trials
MEDLINE
Guidelines

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Tsivgoulis, G., Katsanos, A. H., Grory, B. M., Köhrmann, M., Ricci, B. A., Tsioufis, K., ... Yaghi, S. (2019). Prolonged Cardiac Rhythm Monitoring and Secondary Stroke Prevention in Patients With Cryptogenic Cerebral Ischemia. Stroke, 50(8), 2175-2180. https://doi.org/10.1161/STROKEAHA.119.025169

Prolonged Cardiac Rhythm Monitoring and Secondary Stroke Prevention in Patients With Cryptogenic Cerebral Ischemia. / Tsivgoulis, Georgios; Katsanos, Aristeidis H.; Grory, Brian Mac; Köhrmann, Martin; Ricci, Brittany A.; Tsioufis, Konstantinos; Cutting, Shawna; Krogias, Christos; Schellinger, Peter D.; Campello, Ana Rodriguez; Cuadrado-Godia, Elisa; Gladstone, David J.; Sanna, Tommaso; Wachter, Rolf; Furie, Karen; Alexandrov, Andrei V.; Yaghi, Shadi.

In: Stroke, Vol. 50, No. 8, 01.08.2019, p. 2175-2180.

Research output: Contribution to journalArticle

Tsivgoulis, G, Katsanos, AH, Grory, BM, Köhrmann, M, Ricci, BA, Tsioufis, K, Cutting, S, Krogias, C, Schellinger, PD, Campello, AR, Cuadrado-Godia, E, Gladstone, DJ, Sanna, T, Wachter, R, Furie, K, Alexandrov, AV & Yaghi, S 2019, 'Prolonged Cardiac Rhythm Monitoring and Secondary Stroke Prevention in Patients With Cryptogenic Cerebral Ischemia', Stroke, vol. 50, no. 8, pp. 2175-2180. https://doi.org/10.1161/STROKEAHA.119.025169
Tsivgoulis, Georgios ; Katsanos, Aristeidis H. ; Grory, Brian Mac ; Köhrmann, Martin ; Ricci, Brittany A. ; Tsioufis, Konstantinos ; Cutting, Shawna ; Krogias, Christos ; Schellinger, Peter D. ; Campello, Ana Rodriguez ; Cuadrado-Godia, Elisa ; Gladstone, David J. ; Sanna, Tommaso ; Wachter, Rolf ; Furie, Karen ; Alexandrov, Andrei V. ; Yaghi, Shadi. / Prolonged Cardiac Rhythm Monitoring and Secondary Stroke Prevention in Patients With Cryptogenic Cerebral Ischemia. In: Stroke. 2019 ; Vol. 50, No. 8. pp. 2175-2180.
@article{d7bb7c523cb94244aa09705931f8007e,
title = "Prolonged Cardiac Rhythm Monitoring and Secondary Stroke Prevention in Patients With Cryptogenic Cerebral Ischemia",
abstract = "Background and Purpose- Although prolonged cardiac rhythm monitoring (PCM) can reveal a substantial proportion of ischemic stroke (IS) patients with atrial fibrillation not detected by conventional short-term monitoring, current guidelines indicate an uncertain clinical benefit for PCM. We evaluated the impact of PCM on secondary stroke prevention using data from available to date randomized clinical trials and observational studies. Methods- We performed a comprehensive literature search in MEDLINE, SCOPUS, CENTRAL (Cochrane Central Register of Controlled Trial), and conference proceedings to identify studies reporting stroke recurrence rates in patients with history of cryptogenic IS or transient ischemic attack (TIA) receiving PCM compared with patients receiving conventional (non-PCM) cardiac monitoring. Results- We included 4 studies (2 randomized clinical trials and 2 observational studies), including a total of 1102 patients (mean age: 68 years, 41{\%} women). We documented an increased incidence of atrial fibrillation detection (risk ratio=2.46; 95{\%} CI, 1.61-3.76) and anticoagulant initiation (risk ratio=2.07; 95{\%} CI, 1.36-3.17) and decreased risk of recurrent stroke (risk ratio=0.45; 95{\%} CI, 0.21-0.97) and recurrent stroke/TIA (risk ratio=0.49; 95{\%} CI, 0.30-0.81) during follow-up for IS/TIA patients who underwent PCM compared with IS/TIA patients receiving conventional cardiac monitoring. In the subgroup analysis, according to study type, atrial fibrillation detection, anticoagulant initiation, and IS/TIA recurrence rates were comparable between PCM and non-PCM in randomized clinical trials and observational studies. No evidence of heterogeneity (I2<12{\%}) was documented across all the aforementioned subgroups. Conclusions- We provide preliminary evidence for a potential impact of PCM on secondary stroke prevention, as patients with cryptogenic IS/TIA undergoing PCM had higher rates of atrial fibrillation detection, anticoagulant initiation, and lower stroke recurrence.",
author = "Georgios Tsivgoulis and Katsanos, {Aristeidis H.} and Grory, {Brian Mac} and Martin K{\"o}hrmann and Ricci, {Brittany A.} and Konstantinos Tsioufis and Shawna Cutting and Christos Krogias and Schellinger, {Peter D.} and Campello, {Ana Rodriguez} and Elisa Cuadrado-Godia and Gladstone, {David J.} and Tommaso Sanna and Rolf Wachter and Karen Furie and Alexandrov, {Andrei V.} and Shadi Yaghi",
year = "2019",
month = "8",
day = "1",
doi = "10.1161/STROKEAHA.119.025169",
language = "English (US)",
volume = "50",
pages = "2175--2180",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "8",

}

TY - JOUR

T1 - Prolonged Cardiac Rhythm Monitoring and Secondary Stroke Prevention in Patients With Cryptogenic Cerebral Ischemia

AU - Tsivgoulis, Georgios

AU - Katsanos, Aristeidis H.

AU - Grory, Brian Mac

AU - Köhrmann, Martin

AU - Ricci, Brittany A.

AU - Tsioufis, Konstantinos

AU - Cutting, Shawna

AU - Krogias, Christos

AU - Schellinger, Peter D.

AU - Campello, Ana Rodriguez

AU - Cuadrado-Godia, Elisa

AU - Gladstone, David J.

AU - Sanna, Tommaso

AU - Wachter, Rolf

AU - Furie, Karen

AU - Alexandrov, Andrei V.

AU - Yaghi, Shadi

PY - 2019/8/1

Y1 - 2019/8/1

N2 - Background and Purpose- Although prolonged cardiac rhythm monitoring (PCM) can reveal a substantial proportion of ischemic stroke (IS) patients with atrial fibrillation not detected by conventional short-term monitoring, current guidelines indicate an uncertain clinical benefit for PCM. We evaluated the impact of PCM on secondary stroke prevention using data from available to date randomized clinical trials and observational studies. Methods- We performed a comprehensive literature search in MEDLINE, SCOPUS, CENTRAL (Cochrane Central Register of Controlled Trial), and conference proceedings to identify studies reporting stroke recurrence rates in patients with history of cryptogenic IS or transient ischemic attack (TIA) receiving PCM compared with patients receiving conventional (non-PCM) cardiac monitoring. Results- We included 4 studies (2 randomized clinical trials and 2 observational studies), including a total of 1102 patients (mean age: 68 years, 41% women). We documented an increased incidence of atrial fibrillation detection (risk ratio=2.46; 95% CI, 1.61-3.76) and anticoagulant initiation (risk ratio=2.07; 95% CI, 1.36-3.17) and decreased risk of recurrent stroke (risk ratio=0.45; 95% CI, 0.21-0.97) and recurrent stroke/TIA (risk ratio=0.49; 95% CI, 0.30-0.81) during follow-up for IS/TIA patients who underwent PCM compared with IS/TIA patients receiving conventional cardiac monitoring. In the subgroup analysis, according to study type, atrial fibrillation detection, anticoagulant initiation, and IS/TIA recurrence rates were comparable between PCM and non-PCM in randomized clinical trials and observational studies. No evidence of heterogeneity (I2<12%) was documented across all the aforementioned subgroups. Conclusions- We provide preliminary evidence for a potential impact of PCM on secondary stroke prevention, as patients with cryptogenic IS/TIA undergoing PCM had higher rates of atrial fibrillation detection, anticoagulant initiation, and lower stroke recurrence.

AB - Background and Purpose- Although prolonged cardiac rhythm monitoring (PCM) can reveal a substantial proportion of ischemic stroke (IS) patients with atrial fibrillation not detected by conventional short-term monitoring, current guidelines indicate an uncertain clinical benefit for PCM. We evaluated the impact of PCM on secondary stroke prevention using data from available to date randomized clinical trials and observational studies. Methods- We performed a comprehensive literature search in MEDLINE, SCOPUS, CENTRAL (Cochrane Central Register of Controlled Trial), and conference proceedings to identify studies reporting stroke recurrence rates in patients with history of cryptogenic IS or transient ischemic attack (TIA) receiving PCM compared with patients receiving conventional (non-PCM) cardiac monitoring. Results- We included 4 studies (2 randomized clinical trials and 2 observational studies), including a total of 1102 patients (mean age: 68 years, 41% women). We documented an increased incidence of atrial fibrillation detection (risk ratio=2.46; 95% CI, 1.61-3.76) and anticoagulant initiation (risk ratio=2.07; 95% CI, 1.36-3.17) and decreased risk of recurrent stroke (risk ratio=0.45; 95% CI, 0.21-0.97) and recurrent stroke/TIA (risk ratio=0.49; 95% CI, 0.30-0.81) during follow-up for IS/TIA patients who underwent PCM compared with IS/TIA patients receiving conventional cardiac monitoring. In the subgroup analysis, according to study type, atrial fibrillation detection, anticoagulant initiation, and IS/TIA recurrence rates were comparable between PCM and non-PCM in randomized clinical trials and observational studies. No evidence of heterogeneity (I2<12%) was documented across all the aforementioned subgroups. Conclusions- We provide preliminary evidence for a potential impact of PCM on secondary stroke prevention, as patients with cryptogenic IS/TIA undergoing PCM had higher rates of atrial fibrillation detection, anticoagulant initiation, and lower stroke recurrence.

UR - http://www.scopus.com/inward/record.url?scp=85070184527&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85070184527&partnerID=8YFLogxK

U2 - 10.1161/STROKEAHA.119.025169

DO - 10.1161/STROKEAHA.119.025169

M3 - Article

VL - 50

SP - 2175

EP - 2180

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 8

ER -