H Lehtola1, K E J Airaksinen2, P Hartikainen3, J E K Hartikainen4, A Palomäki2, I Nuotio5, A Ylitalo2,6, T Kiviniemi2, P Mustonen1. 1. Department of Medicine, Keski-Suomi Central Hospital, Jyvaskyla, Finland. 2. Heart Center, Turku University Hospital, University of Turku, Turku, Finland. 3. Neurology, NeuroCenter, Kuopio University Hospital, Kuopio, Finland. 4. Heart Center, Kuopio University Hospital, Kuopio, Finland. 5. Department of Acute Medicine, Turku University Hospital, University of Turku, Turku, Finland. 6. Satakunta Central Hospital, Pori, Finland.
Abstract
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.
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 AFpatients 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 AFpatients with an ischaemic stroke or transient ischaemic attack (TIA) during 2003-2012. In this sub-study, 165 AFpatients with ischaemic stroke or TIA with significant (>50%) CAS (CAS group) and 734 AFpatients 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 CASpatients compared to the non-CAS group despite similar anticoagulation/antithrombotic therapy. CASpatients had higher mean CHA2 DS2 -VASc scores than non-CASpatients (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 CASpatients (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.
Authors: B Pardo-Galiana; M Medina-Rodriguez; M Millan-Vazquez; J A Cabezas-Rodriguez; L Lebrato-Hernandez; L Ainz-Gomez; E Zapata-Arriaza; J Ortega; A de Albóniga-Chindurza; J Montaner; A Gonzalez; F Moniche Journal: AJNR Am J Neuroradiol Date: 2022-04-07 Impact factor: 3.825
Authors: Heidi Lehtola; Juha Hartikainen; Päivi Hartikainen; Tuomas Kiviniemi; Ilpo Nuotio; Antti Palomäki; Antti Ylitalo; K E Juhani Airaksinen; Pirjo Mustonen Journal: Clin Cardiol Date: 2018-05-10 Impact factor: 2.882