Abstract
Background: Atrial fibrillation (AF) shares several risk factors with atherosclerosis. We investigated the association between total carotid plaque number (TPN) and long-term prognosis in ischemic stroke patients with AF. Methods: A total of 392 ischemic stroke patients with AF who underwent carotid ultrasonography were enrolled. TPN was assessed using B-mode ultrasound. The patients were categorized into two groups according to best cutoff values for TPN (TPN ≤ 4 vs. TPN ≥ 5). The long-term risk of major adverse cardiovascular events (MACE) and mortality according to TPN was investigated using a Cox hazard model. Results: After a mean follow-up of 2.42 years, 113 patients (28.8%) had developed MACE and 88 patients (22.4%) had died. MACE occurred more frequently in the TPN ≥ 5 group than in the TPN ≤ 4 group (adjusted hazard ratio [HR], 1.50; 95% confidence interval [CI], 1.01–2.21; p < 0.05). Moreover, the TPN ≥ 5 group showed an increased risk of all-cause mortality (adjusted HR, 2.69; 95% CI, 1.40–5.17; p < 0.05). TPN along with maximal plaque thickness and intima media thickness showed improved prognostic utility when added to the variables of the CHAD2DS2-VASc score. Conclusion: TPN can predict the long-term outcome of ischemic stroke patients with AF. Adding TPN to the CHAD2DS2-VASc score increases the predictability of outcome after stroke.
Highlights
Atrial fibrillation (AF) is the most common cause of cardioembolic stroke and is associated with poor prognosis in survivors after ischemic stroke
We evaluated the association between the total carotid plaque number (TPN) and long-term prognosis in ischemic stroke patients with AF
The present study revealed that carotid plaque burden of < 50% carotid stenosis was a strong prognostic marker in patients with AF
Summary
Atrial fibrillation (AF) is the most common cause of cardioembolic stroke and is associated with poor prognosis in survivors after ischemic stroke. Carotid atherosclerosis ≥ 50% in patients with AF is well known to be an independent risk factor for future ischemic stroke and vascular events [7,8,9]. Little is known about the prognostic impact of the number of carotid plaques on the outcome of patients with AF. In this regard, we evaluated the association between the total carotid plaque number (TPN) and long-term prognosis in ischemic stroke patients with AF. We investigated the association between total carotid plaque number (TPN) and long-term prognosis in ischemic stroke patients with AF. The long-term risk of major adverse cardiovascular events (MACE) and mortality according to TPN was investigated using a Cox hazard model. Adding TPN to the CHAD2DS2-VASc score increases the predictability of outcome after stroke
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