Background
Patients with carotid arterial disease (CD) with and without atrial fibrillation (AF)
are at risk of stroke. Patients with AF are at a higher risk of stroke and dementia.
Objectives
We sought to understand the risks of stroke, transient ischemic attack (TIA), and
dementia in patients with and without AF and CD or a combination of both as well as
to determine whether therapies for each disease may influence risks.
Methods
A total of 11,572 patients were included in 4 groups, with 2893 patients populating
each group (1: no AF or CD; 2: AF, no CD; 3: CD and no AF; 4: AF and CD) and matched
for age, sex, and comorbidities. Long-term outcomes of stroke/TIA and dementia were
assessed. Subset analyses of these outcomes were performed in patients with CD treated
with revascularization and in patients with AF treated with ablation.
Results
CD increased the risk of stroke/TIA (hazard ratio [HR] 2.74; P < .0001) and dementia (HR 1.44; P < .0001). Similarly, AF increased the risk of stroke/TIA (HR 2.08; P < .0001) and dementia (HR 1.30; P = .004). The coexistence of AF and CD further augmented the risk of both end points.
CD revascularization was associated with a decreased risk of dementia (HR 0.47; P < .0001) but not stroke. Ablation of AF improved outcomes of stroke/TIA (HR 0.55;
P = .002), particularly in those with CD (HR 0.36; P < .0001), and was associated with a reduced risk of dementia (HR 0.51; P = .04).
Conclusion
CD and AF augment risk of stroke/TIA and dementia in the general population, and the
coexistence of both diseases is additive in risk. Ablation of AF was associated with
lower risk, the magnitude of which was greater in those with CD.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: July 09, 2019
Footnotes
Dr Bunch has received research grants from Boehringer Ingelheim, Ingelheim am Rhein, Germany, and Boston Scientific. Dr Osborn has received honorarium/consulting fees from Abbott Medical, Boston Scientific, Medtronic, and Spectranetics. Dr Weiss has received honorarium/consulting fees from Talon Medical and Stereotaxis. Dr Day has received honorarium/consulting fees from Abbott Medical, Boston Scientific, and Medtronic. The rest of the authors report no conflicts of interest.
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