Abstract 19081: Renal Insufficiency as a Marker for Stroke Risk in Patients with Atrial Fibrillation
Background: Renal function is closely associated with cardiovascular disease. However, there are limited data about the relationship between renal function and stroke risk in patients with atrial fibrillation.
Methods: Consecutive patients who underwent cardioversion for nonvalvular atrial fibrillation or flutter between January 2000 and December 2005 were studied. Clinical and laboratory data on risk factors, renal function, and a history of stroke was collected at the time of the cardioversion. Multivariate analysis for risk factors associated with a history of stroke was adjusted for age, gender, hypertension, diabetes, and CHF. Patients with normal glomerular filtration rate (GFR) > 60 mL/min were used as the comparison group.
Results: A total of 1,424 patients, with a mean age 70 ± 12 years were identified. 140 (11.7%) had a history of stroke or transient ischemic attack (TIA). Patients with renal insufficiency, defined as GFR<60 mL/min, were older, more likely to have hypertension and CHF (p<0.001). Warfarin use and diabetes were not significantly different in patients with or without renal insufficiency (p=0.29 and p=0.54, respectively). Patients with renal insufficiency were more likely to have a history of stroke or TIA (GFR < 40 mL/min = 15%, GFR 40–60 mL/min = 12%, GFR > 60 mL/min = 5% stroke; p<0.001). Multivariate analysis demonstrated that renal insufficiency remained a significant predictor of stroke after adjusting for other factors (Figure 1).
Conclusion: Renal insufficiency is associated with a history of stroke in patients with atrial fibrillation. Additional studies are needed to determine if more aggressive anticoagulation strategies are required in these patients.
- © 2010 by American Heart Association, Inc.