The Value of the Score for the Targeting of Atrial Fibrillation (STAF) Screening in Acute Stroke Patients.

BACKGROUND AND PURPOSE: Recently, the score for the targeting of atrial fibrillation (STAF) was introduced to identify the risk of atrial fibrillation (AF) in stroke patients. In this study, we aim to evaluate the usefulness of the STAF score for AF screening in acute stroke patients. METHODS: Patients with acute ischemic stroke who were admitted to our stroke unit were prospectively enrolled from March 2011 to March 2013. Baseline National Institutes of Health Stroke Scale (NIHSS), left atrial dilatation, and vascular etiology were assessed to calculate the STAF score. Logistic regression analysis was used to examine the relationship between AF and STAF factors. Univariate analysis of AF and age, history of coronary heart disease and rheumatic heart disease, NIHSS, left atrial dilatation, and vascular etiology was performed. RESULTS: A total of 472 patients were enrolled in our analysis. AF was documented in 78 (16.53%) patients, of which 50% were paroxysmal. Multivariable analysis demonstrated that age, NIHSS, left atrial dilatation, and the absence of vascular etiology can each function as independent predictors for AF. In addition, all AF patients with a STAF ≥5 show a sensitivity of 76.92% and a specificity of 78.68%. The area under the receiver operating characteristic for all AF patients was .842 versus .763 for the paroxysmal AF (pAF) patients. In addition, a sensitivity of 81% (95% CI 73-92) and a ROC of .829 were for new-AF. CONCLUSIONS: The value of the STAF system for predicting the risk of pAF and new-AF in stroke patients is relatively limited.

[The statin dosage for achieving goal of cholesterol-lowering based on risk stratification in patients with ischemic cerebrovascular diseases].

OBJECTIVE: To explore statin dosages for targeting goal of LDL-C lowering on the basis of stroke risk stratification and the dosage-effective relation of statin and LDL-C lowering in Chinese patients with ischemic stroke and transient ischemic attack (TIA). METHODS: This is a prospective and open clinical trial patients with ischemic stroke/TIA within 6 months were enrolled and the dosages of atorvastatin were calculated based on risk stratification according to "Chinese Consensus for Prevention of Ischemic Stroke/TIA with Statin" (Chinese Consensus). A dose of 10 mg of atorvastatin daily to target LDL-C goal was taken as the standard dosage targeting goal (SDTG). Patients taking this dosage of atorvastatin constituted a SDTG group. Those who needed a daily dose of 20 mg or more of atorvastatin were randomized into an intensive dosage targeting goal (IDTG) group (atorvastatin 20 - 80 mg/d) and a standard dosage non-targeting goal (SDNTG) group (atorvastatin 10 mg/d without targeting goal). All patients took atorvastatin for 12 weeks. The primary outcome was the rate of targeting goal for LDL-C lowering at 2, 4 and 12 weeks, respectively and the secondary outcome was the occurence of recurrent stroke and other vascular events within 12 weeks. The main safety endpoint was serial adverse events including symptomatic intracranial hemorrhage. RESULTS: Altogether 102 cases were enrolled and 99 cases were followed up for 12 weeks. According to the Chinese Consensus, the rate of high risk, very high risk-I and very high risk-II was 44%, 28% and 28%, respectively. Targeting rate for LDL-C lowering was 77% - 85% at each time point in the SDTG and IDTG groups, being significantly higher than those in the SDNTG group (12% - 16%, P < 0.01). No significant difference was found concerning the occurrence of recurrent stroke, other vascular events and safety endpoints among the three groups. The amplitude of LDL-C lowering was 32% - 35%, 46% - 49%, 51% - 52% and 60% - 65% with corresponding to daily dosage of 10 mg, 20 mg, 40 mg and 80 mg atorvastatin. CONCLUSIONS: At least more than half of the patients after ischemic stroke/TIA need intensive statin therapy to target the LDL-C lowering goal. The dosage-effective relation of atorvastatin and LDL-C lowering in Chinese is similar to the reported data in other races.