Premium
Stroke recurrence in patients with atrial fibrillation: concomitant carotid artery stenosis doubles the risk
Author(s) -
Lehtola H.,
Airaksinen K. E. J.,
Hartikainen P.,
Hartikainen J. E. K.,
Palomäki A.,
Nuotio I.,
Ylitalo A.,
Kiviniemi T.,
Mustonen P.
Publication year - 2017
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.13280
Subject(s) - medicine , atrial fibrillation , stroke (engine) , interquartile range , cardiology , hazard ratio , stenosis , concomitant , risk factor , confidence interval , surgery , mechanical engineering , engineering
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, CHA 2 DS 2 ‐ VAS c 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 CHA 2 DS 2 ‐ VAS c 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.