2162Coronary artery disease is an independent risk factor for ischemic stroke among patients with atrial fibrillation

Steensig, Kamilla; Olesen, Kevin Kris Warnakula; Thim, Troels; Nielsen, Jens Cosedis; Madsen, Morten; Jensen, Susanne; Jensen, Lisette Okkels; Kristensen, Steen Dalby; Boetker, H.E.; Lip, Gregory Y.H.; Mæng, Michael

doi:10.1093/eurheartj/ehy565.2162

Cited by 6 publications

(10 citation statements)

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“…In contrast, prior studies have associated ischaemic stroke risk with PAD, previous MI and complex aortic plaque documented on imaging, 4 and we have recently shown that the presence of CAD is an independent risk factor for future ischaemic stroke/ TIA and systemic embolism in patients with AF. 5 The aim of this study was to test the hypothesis that the extent of CAD, documented by coronary angiography (CAG), provides independent prognostic information of future ischaemic stroke and TE in patients with AF. Further, we tested the clinical impact of including CAD in the vascular component of the CHA 2 DS 2 -VASc score.…”

Section: Introductionmentioning

confidence: 99%

Should the Presence or Extent of Coronary Artery Disease be Quantified in the CHA2DS2-VASc Score in Atrial Fibrillation? A Report from the Western Denmark Heart Registry

et al. 2018

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Background Patients with atrial fibrillation (AF) have an increased risk of ischaemic stroke. The risk can be predicted by the CHA2DS2-VASc score, in which the vascular component refers to previous myocardial infarction, peripheral artery disease and aortic plaque, whereas coronary artery disease (CAD) is not included. Objectives This article explores whether CAD per se or extent provides independent prognostic information of future stroke among patients with AF. Materials and Methods Consecutive patients with AF and coronary angiography performed between 2004 and 2012 were included. The endpoint was a composite of ischaemic stroke, transient ischaemic attack and systemic embolism. The risk of ischaemic events was estimated according to the presence and extent of CAD. Incidence rate ratios (IRR) were calculated in reference to patients without CAD and adjusted for parameters included in the CHA2DS2-VASc score and treatment with anti-platelet agents and/or oral anticoagulants. Results Of 96,430 patients undergoing coronary angiography, 12,690 had AF. Among patients with AF, 7,533 (59.4%) had CAD. Mean follow-up was 3 years. While presence of CAD was an independent risk factor for the composite endpoint (adjusted IRR, 1.25; 1.06–1.47), extent of CAD defined as 1-, 2-, 3- or diffuse vessel disease did not add additional independent risk information. Conclusion Presence, but not extent, of CAD was an independent risk factor of the composite thromboembolic endpoint beyond the components already included in the CHA2DS2-VASc score. Consequently, we suggest that significant angiographically proven CAD should be included in the vascular disease criterion in the CHA2DS2-VASc score.

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Section: Introductionmentioning

confidence: 99%

Should the Presence or Extent of Coronary Artery Disease be Quantified in the CHA2DS2-VASc Score in Atrial Fibrillation? A Report from the Western Denmark Heart Registry

et al. 2018

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“…[18–20] Recent study also suggested that CAD is an independent risk factor for ischemic stroke among patients with AF (adjusted incidence rate ratios: 1.29; 95% CI: 1.08–1.53). [21] In the Framingham study, coronary heart disease with AF was associated with an increased risk of stroke by 2-fold in men and nearly 5-fold in women compared with those without AF. [22] In addition, intracranial hemorrhage is increased in patients with AF due to the use of antithrombotic and anticoagulant medication.…”

Section: Discussionmentioning

confidence: 99%

Effect of atrial fibrillation in Asian patients undergoing percutaneous coronary intervention with drug-eluting stents for stable coronary artery disease

et al. 2018

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Although the prevalence of atrial fibrillation (AF) and percutaneous coronary intervention (PCI) are increasing in Asia, there is a paucity of data concerning the effect of AF in Asian patients undergoing PCI with drug-eluting stents (DESs). Furthermore, the majority of previous studies investigating the effect of AF on prognosis following PCI have exclusively evaluated patients with myocardial infarction (MI). We aimed to evaluate the effect of AF on clinical outcomes of Asian patients undergoing PCI with DES for coronary artery disease (CAD) excluding acute MI.From national health insurance claims data in South Korea, a total of 45,288 patients aged 18 years or older without a known history of CAD, who underwent PCI with DES for the diagnosis of CAD excluding acute MI between 2011 and 2015, were enrolled. Based on the presence or absence of a history of AF at baseline, patients were categorized into the AF group (n = 1715, 3.8%) and no-AF group (n = 43,573, 96.2%). Outcomes including all-cause death, the composite outcome of all-cause death/MI/coronary revascularization, and stroke were compared between 2 groups using a propensity-score-matched analysis.After propensity-score matching, 1709 matched pairs were obtained. During the follow-up period (mean, 2.2 years), the incidence of all-cause death (hazard ratio [HR] 1.117, 95% confidence interval [CI] 0.885–1.411, P = .35) and the composite outcome of all-cause death/MI/coronary revascularization (HR 1.004, 95% CI 0.846–1.192, P = .97) were not significantly different between 2 groups. However, the incidence of stroke was significantly increased in the AF group (HR 1.983, 95% CI 1.474–2.667, P < .001).In Asian patients undergoing PCI for stable CAD, a history of AF was not associated with mortality, but was associated with increased risk of stroke.

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“…The significance of vascular disease or diabetes mellitus were attenuated after multivariate adjustment, and female sex (HR, 0.73; 95% CI, 0.64–0.84) had a lower risk of ischemic stroke than male sex in Korean NHIS sample cohort (Table 5). 9)126) Coronary and peripheral artery disease have been reported to be important independent risks for stroke in AF 127)128). Several cohort studies have shown that female sex is a risk factor for stroke, although this is dependent on age and the presence of other non-sex risk factors 129)130)131)132)133).…”

Section: Stroke Prevention Therapy In Atrial Fibrillation Patientsmentioning

confidence: 99%

2018 Korean Guideline of Atrial Fibrillation Management

et al. 2018

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Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in the general population. The Korean Heart Rhythm Society organized a Korean AF Management Guideline Committee and analyzed all available studies regarding the management of AF, including studies on Korean patients. This guideline is based on recent data of the Korean population and the recent guidelines of the European Society of Cardiology, European Association for Cardio-Thoracic Surgery, American Heart Association, and Asia Pacific Heart Rhythm Society. Expert consensus or guidelines for the optimal management of Korean patients with AF were achieved after a systematic review with intensive discussion. This article provides general principles for appropriate risk stratification and selection of anticoagulation therapy in Korean patients with AF. This guideline deals with optimal stroke prevention, screening, rate and rhythm control, risk factor management, and integrated management of AF.

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2162Coronary artery disease is an independent risk factor for ischemic stroke among patients with atrial fibrillation

Cited by 6 publications

References 0 publications

Should the Presence or Extent of Coronary Artery Disease be Quantified in the CHA2DS2-VASc Score in Atrial Fibrillation? A Report from the Western Denmark Heart Registry

Should the Presence or Extent of Coronary Artery Disease be Quantified in the CHA2DS2-VASc Score in Atrial Fibrillation? A Report from the Western Denmark Heart Registry

Effect of atrial fibrillation in Asian patients undergoing percutaneous coronary intervention with drug-eluting stents for stable coronary artery disease

2018 Korean Guideline of Atrial Fibrillation Management

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