George Ntaios1, Kalliopi Perlepe2, Gaia Sirimarco2, Davide Strambo2, Ashraf Eskandari2, Efstathia Karagkiozi2, Anastasia Vemmou2, Eleni Koroboki2, Efstathios Manios2, Konstantinos Makaritsis2, Patrik Michel2, Konstantinos Vemmos2. 1. From the Department of Medicine (G.N., K.P., E.K., K.M.), Larissa University Hospital, School of Medicine, University of Thessaly, Greece; Stroke Center and Neurology Service, Department of Clinical Neurosciences (G.S., D.S., A.E., P.M.), Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland; Department of Clinical Therapeutics (A.V., E.K., E.M., K.V.), Medical School of Athens, Alexandra Hospital; and Department of Neurology (E,K,), National and Kapodistrian University of Athens, Greece. gntaios@med.uth.gr. 2. From the Department of Medicine (G.N., K.P., E.K., K.M.), Larissa University Hospital, School of Medicine, University of Thessaly, Greece; Stroke Center and Neurology Service, Department of Clinical Neurosciences (G.S., D.S., A.E., P.M.), Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland; Department of Clinical Therapeutics (A.V., E.K., E.M., K.V.), Medical School of Athens, Alexandra Hospital; and Department of Neurology (E,K,), National and Kapodistrian University of Athens, Greece.
Abstract
OBJECTIVE: To investigate the association between the presence of ipsilateral nonstenotic carotid plaques and the rate of detection of atrial fibrillation (AF) during follow-up in patients with embolic strokes of undetermined source (ESUS). METHODS: We pooled data of all consecutive ESUS patients from 3 prospective stroke registries. Multivariate stepwise regression assessed the association between the presence of nonstenotic carotid plaques and AF detection. The 10-year cumulative probabilities of AF detection were estimated by the Kaplan-Meier product limit method. RESULTS: Among 777 patients followed for 2,642 patient-years, 341 (38.6%) patients had an ipsilateral nonstenotic carotid plaque. AF was detected in 112 (14.4%) patients in the overall population during follow-up. The overall rate of AF detection was 8.5% in patients with nonstenotic carotid plaques (2.9% per 100 patient-years) and 19.0% in patients without (5.0% per 100 patient-years) (unadjusted hazard ratio [HR] 0.56, 95% confidence interval [CI] 0.37-0.84). The presence of ipsilateral nonstenotic carotid plaques was associated with lower probability for AF detection (adjusted HR 0.57, 95% CI 0.34-0.96, p = 0.03). The 10-year cumulative probability of AF detection was lower in patients with ipsilateral nonstenotic carotid plaques compared to those without (34.5%, 95% CI 21.8-47.2 vs 49.0%, 95% CI 40.4-57.6 respectively, log-rank-test: 11.8, p = 0.001). CONCLUSIONS: AF is less frequently detected in ESUS patients with nonstenotic carotid plaques compared to those without. CLINICALTRIALSGOV IDENTIFIER: NCT02766205.
OBJECTIVE: To investigate the association between the presence of ipsilateral nonstenotic carotid plaques and the rate of detection of atrial fibrillation (AF) during follow-up in patients with embolic strokes of undetermined source (ESUS). METHODS: We pooled data of all consecutive ESUS patients from 3 prospective stroke registries. Multivariate stepwise regression assessed the association between the presence of nonstenotic carotid plaques and AF detection. The 10-year cumulative probabilities of AF detection were estimated by the Kaplan-Meier product limit method. RESULTS: Among 777 patients followed for 2,642 patient-years, 341 (38.6%) patients had an ipsilateral nonstenotic carotid plaque. AF was detected in 112 (14.4%) patients in the overall population during follow-up. The overall rate of AF detection was 8.5% in patients with nonstenotic carotid plaques (2.9% per 100 patient-years) and 19.0% in patients without (5.0% per 100 patient-years) (unadjusted hazard ratio [HR] 0.56, 95% confidence interval [CI] 0.37-0.84). The presence of ipsilateral nonstenotic carotid plaques was associated with lower probability for AF detection (adjusted HR 0.57, 95% CI 0.34-0.96, p = 0.03). The 10-year cumulative probability of AF detection was lower in patients with ipsilateral nonstenotic carotid plaques compared to those without (34.5%, 95% CI 21.8-47.2 vs 49.0%, 95% CI 40.4-57.6 respectively, log-rank-test: 11.8, p = 0.001). CONCLUSIONS:AF is less frequently detected in ESUS patients with nonstenotic carotid plaques compared to those without. CLINICALTRIALSGOV IDENTIFIER: NCT02766205.
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