Stroke recurrence in patients with atrial fibrillation: concomitant carotid artery stenosis doubles the risk.
OBJECTIVE
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, CHA2DS2-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 CHA2DS2-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.
Department of Medicine, Keski-Suomi Central Hospital, Jyvaskyla, Finland.
H
H
Lehtola
Heart Center, Turku University Hospital, University of Turku, Turku, Finland.
K E J
KEJ
Airaksinen
Neurology, NeuroCenter, Kuopio University Hospital, Kuopio, Finland.
P
P
Hartikainen
Heart Center, Kuopio University Hospital, Kuopio, Finland.
J E K
JEK
Hartikainen
Heart Center, Turku University Hospital, University of Turku, Turku, Finland.
A
A
Palomäki
Department of Acute Medicine, Turku University Hospital, University of Turku, Turku, Finland.
I
I
Nuotio
Heart Center, Turku University Hospital, University of Turku, Turku, Finland.|Satakunta Central Hospital, Pori, Finland.
A
A
Ylitalo
Heart Center, Turku University Hospital, University of Turku, Turku, Finland.
T
T
Kiviniemi
Department of Medicine, Keski-Suomi Central Hospital, Jyvaskyla, Finland.
P
P
Mustonen
D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000453:epidemiology*; D002545:Brain Ischemia / Q000453:epidemiology*; D016893:Carotid Stenosis / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002546:Ischemic Attack, Transient / Q000453:epidemiology; D008297:Male; D012008:Recurrence; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*
atrial fibrillation; carotid artery stenosis; cerebral infarction; stroke