Atherosclerotic Burden and Vascular Risk in Stroke Patients With Atrial Fibrillation
- 주제(키워드) atherosclerotic disease , atrial fibrillation , carotid artery stenosis , outcome , stroke
- 주제(기타) Clinical Neurology
- 주제(기타) Peripheral Vascular Disease
- 설명문(일반) [Park, Jong-Ho] Hanyang Univ, Myongji Hosp, Dept Neurol, Coll Med, 55 Hwasuro 14beon Gil, Goyang 10475, South Korea; [Chung, Jong-Won; Bang, Oh Young; Kim, Gyeong-Moon; Seo, Woo-Keun] Sungkyunkwan Univ, Samsung Med Ctr, Dept Neurol, Sch Med, Seoul, South Korea; [Choi, Kang-Ho; Park, Man-Seok; Kim, Joon-Tae] Chonnam Natl Univ Hosp, Dept Neurol, Gwangju, South Korea; [Hwang, Yang-Ha] Kyungpook Natl Univ, Kyungpook Natl Univ Hosp, Sch Med, Dept Neurol, Daegu, South Korea; [Song, Tae-Jin] Ewha Womans Univ, Coll Med, Dept Neurol, Seoul Hosp, Seoul, South Korea; [Kim, Yong-Jae] Catholic Univ Korea, Dept Neurol, Eunpyeong St Marys Hosp, Seoul, South Korea; [Kim, Bum Joon] Univ Ulsan, Asan Med Ctr, Dept Neurol, Coll Med, Seoul, South Korea; [Heo, Sung Hyuk] Kyung Hee Univ, Dept Neurol, Coll Med, Seoul, South Korea; [Jung, Jin-Man] Korea Univ, Dept Neurol, Ansan Hosp, Coll Med, Seoul, South Korea; [Oh, Kyungmi; Kim, Chi Kyung] Korea Univ, Guro Hosp, Dept Neurol, Coll Med, Seoul, South Korea; [Yu, Sungwook] Korea Univ, Anam Hosp, Dept Neurol, Coll Med, Seoul, South Korea; [Park, Kwang Yeol] Chung Ang Univ, Dept Neurol, Coll Med, Seoul, South Korea; [Kim, Jeong-Min] Seoul Natl Univ Hosp, Dept Neurol, Seoul, South Korea; [Choi, Jay Chol] Jeju Natl Univ, Dept Neurol, Jeju City, South Korea
- 등재 SCIE, SCOPUS
- 발행기관 LIPPINCOTT WILLIAMS & WILKINS
- 발행년도 2021
- 총서유형 Journal
- URI http://www.dcollection.net/handler/ewha/000000181571
- 본문언어 영어
- Published As http://dx.doi.org/10.1161/STROKEAHA.120.032232
초록/요약
Background and Purpose: Data on the effect on vascular outcomes of concomitant atherosclerotic vascular disease (ASVD) with atrial fibrillation (AF) after stroke are limited. This study evaluated the effect of ASVD with AF versus AF only on the risk of vascular events. Methods: We retrospectively analyzed a prospectively registered multicenter database involving 3213 stroke patients with AF. ASVD included extracranial atherosclerosis measured in the proximal portion of the internal carotid artery, intracranial atherosclerosis (all >= 50% stenosis), coronary artery disease, and peripheral artery disease and was categorized into 4 strata depending on the number of ASVDs (0, 1, 2, and 3-4). The independent associations of ASVD with major adverse cardiovascular events, stroke, and all-cause death were assessed. Results: A total of 2670 patients were included (mean age, 73.5 +/- 9.8 years; median CHA(2)DS(2)-VASc score, 5; interquartile range, 4-6). During the follow-up (mean, 1.7 years), a total of 672 (25.2%) major adverse cardiovascular events, 170 (6.4%) stroke events, and 501 (18.8%) all-cause deaths were noted. The adjusted hazard ratio for major adverse cardiovascular events versus no ASVD was 1.25 (95% CI, 1.00-1.56) for ASVD 1, 1.34 (95% CI, 1.02-1.76) for ASVD 2, and 1.93 (95% CI, 1.24-2.99) for ASVD 3-4. The adjusted hazard ratio for all-cause death versus no ASVD was 1.32 (1.01-1.74), 1.47 (1.06-2.03), and 2.39 (1.47-3.89), respectively. Among ASVD components, the presence of symptomatic or asymptomatic extracranial atherosclerosis was a more potent predictor of major adverse cardiovascular events (1.27 [1.05-1.54]) and all-cause death (1.45 [1.17-1.81]). Conclusions: ASVD burden with AF can be a cumulative marker of a high risk for untoward vascular outcomes. Among ASVD components, extracranial atherosclerosis seems to have a predominant effect.
more