Stroke recurrence in patients with atrial fibrillation: concomitant carotid artery stenosis doubles the risk
H Lehtola1, K E J Airaksinen2, P Hartikainen3
1Department of Medicine, Keski-Suomi Central Hospital, Jyvaskyla, Finland.
Insights
Carotid artery stenosis (CAS) significantly increases stroke recurrence risk in atrial fibrillation (AF) patients, even with anticoagulation. CAS also independently raises 30-day mortality risk in these patients.
Area of Science:
- Cardiology
- Neurology
- Vascular Surgery
Background:
- Atrial fibrillation (AF) and carotid artery stenosis (CAS) frequently co-occur in acute stroke patients.
- The impact of CAS on stroke recurrence in AF patients on anticoagulation is not well understood.
Purpose of the Study:
- To evaluate the effect of concomitant CAS on stroke recurrence and short-term mortality in patients with AF.
- To determine if CAS is an independent risk factor for adverse outcomes in AF stroke patients.
Main Methods:
- Retrospective analysis of the multicentre FibStroke registry (2003-2012).
- Inclusion of AF patients with ischemic stroke/TIA, comparing those with significant CAS (>50%) to those without.
- Assessment of long-term stroke recurrence, 30-day mortality, CHA2DS2-VASc scores, and anticoagulation status.
Main Results:
- Stroke recurrence was significantly higher in the CAS group (21.2% vs. 12.7%, P=0.005).
- CAS was an independent risk factor for stroke recurrence (HR 2.02, P=0.001) and 30-day mortality (OR 3.34, P=0.003).
- CAS patients had higher CHA2DS2-VASc scores and 30-day mortality (7.9% vs. 1.9%, P<0.001).
Conclusions:
- Concomitant carotid artery stenosis is an independent risk factor for long-term stroke recurrence in AF patients.
- Significant CAS independently increases 30-day mortality risk in patients with atrial fibrillation and stroke.
Background And Purpose:
Atrial fibrillation (AF) and significant carotid artery stenosis (CAS) often coexist in patients with acute stroke but whether CAS affects the stroke recurrence rate in anticoagulated AF patients is largely unknown. The effect of concomitant CAS on both short- and long-term prognosis after stroke in patients with AF was evaluated.
Methods:
The multicentre, retrospective FibStroke registry included AF patients with an ischaemic stroke or transient ischaemic attack (TIA) during 2003-2012. In this sub-study, 165 AF patients with ischaemic stroke or TIA with significant (>50%) CAS (CAS group) and 734 AF patients without CAS (non-CAS group) were identified. The median follow-up time after an index event was 3.5 (interquartile range 3.9) years. Long-term stroke recurrence rate, 30-day mortality, CHA2 DS2 -VASc score, other risk factors and the use and intensity of anticoagulation were assessed.
Results:
The recurrence rate of ischaemic stroke (21.2% vs. 12.7%, P = 0.005, 8.1 vs. 3.6 events per100 follow-up years) was significantly higher in CAS patients compared to the non-CAS group despite similar anticoagulation/antithrombotic therapy. CAS patients had higher mean CHA2 DS2 -VASc scores than non-CAS patients (4.3 vs. 3.3, P < 0.001). However, in a multivariate analysis CAS was shown to be an independent risk factor for stroke recurrence (hazard ratio 2.02, 95% confidence interval 1.37-3.01, P = 0.001). The 30-day all-cause mortality was significantly higher in CAS patients (7.9% vs. 1.9%, P < 0.001) and CAS was an independent risk factor also for 30-day mortality (odds ratio 3.34, 95% confidence interval 1.51-7.38, P = 0.003).
Conclusions:
In patients with AF, concomitant CAS was an independent risk factor for both long-term stroke recurrence and 30-day mortality.
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