Clinical pictures of cardioembolic brain infarction (CEBI) are the most serious among ischemic stroke subtypes. Patients with CEBI associated with nonvalvular atrial fibrillation (NVAF) are dramatically increasing in Japan. We aimed to clarify the current status of CEBI in Japan.
We participated in nation-wide, prospective registration studies for acute stroke, Japan Multicenter Stroke Investigators' Collaboration (J-MUSIC; Chief T. Yamaguchi) and Japanese Standard Stroke Registration Study (JSSRS; Chief S. Kobayashi). We analyzed clinical pictures and management in patients with CEBI admitted to the hospitals within the first 7 days and registered to the studies.
The results were almost consistent between the studies. CEBI accounted for 20% (J-MUSIC) or 27% (JSSRS) of acute ischemic stroke. The most frequent cause was NVAF. Both NIH Stroke Scale (NIHSS) and modified Rankin Scale (m-RS) scores in CEBI were the highest among ischemic stroke subtypes. In JSSRS, a multivariate analysis demonstrated that old age, high NIHSS score on admission, hemorrhagic transformation, recurrent stroke during hospitalization, and management without thrombolytic therapy were significant predictors for dependent outcome and death.
It is desired to establish the optimal treatment strategies against CEBI. They include primary prevention, hyperacute interventions such as thombolytic therapy, and measures avoiding early recurrence and symptomatic intracranial hemorrhage.