A1 Vertaisarvioitu alkuperäisartikkeli tieteellisessä lehdessä
Stroke recurrence in patients with atrial fibrillation: concomitant carotid artery stenosis doubles the risk
Tekijät: Lehtola H, Airaksinen KEJ, Hartikainen P, Hartikainen JEK, Palomaki A, Nuotio I, Ylitalo A, Kiviniemi T, Mustonen P
Kustantaja: WILEY
Julkaisuvuosi: 2017
Journal: European Journal of Neurology
Tietokannassa oleva lehden nimi: EUROPEAN JOURNAL OF NEUROLOGY
Lehden akronyymi: EUR J NEUROL
Vuosikerta: 24
Numero: 5
Aloitussivu: 719
Lopetussivu: 725
Sivujen määrä: 7
ISSN: 1351-5101
eISSN: 1468-1331
DOI: https://doi.org/10.1111/ene.13280
Tiivistelmä
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)-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 CHA(2)DS(2)-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 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)-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 CHA(2)DS(2)-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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