Cervicocerebral atherosclerosis and atrial fibrillation increase long-term mortality in patients with ischemic stroke

BACKGROUND AND AIMS: Atrial fibrillation (AF) and atherosclerosis in the arteries supplying the brain are both strong risk factors of ischemic cerebrovascular events. However, the effect of their concurrent presence on long-term mortality in patients with acute ischemic stroke or transient ischemic attack (TIA) has gone little studied. METHODS: A total of 406 patients with acute ischemic stroke or TIA were enrolled in a tertiary university center and their cervicocerebral arteries imaged with computed tomography angiography (CTA). The extent of atherosclerosis in the carotid, vertebral and intracranial arteries were rated as Cervicocerebral Atherosclerotic Burden (CAB) score. Furthermore, we assessed the combined effect of atherosclerosis and AF with a variable including AF status and CAB score in quartiles. RESULTS: After a median follow-up of 7.3 years (interquartile range 5.7-7.6), 62 of the 121 patients with AF had died, compared to 74 of 285 patients without AF (cumulative mortality rate 52.0 %, 95 % CI 47.1-56.9 % vs. 27.0 %, 24.7-29.3 %, respectively). In adjusted Cox regression, the two highest CAB score quartiles were associated with mortality in AF patients with hazard ratios of 12.7 (1.6-99.7) and 15.8 (2.0-126.4), respectively. Furthermore, with combined variable of AF and CAB score the risk of death was 3-fold in AF patients with two highest quartiles of CAB score compared to those without AF in the two lowest CAB score quartiles. CONCLUSIONS: The total atherosclerotic burden in arteries supplying the brain appears as a strong independent factor increasing long-term mortality in patients with acute ischemic stroke or TIA and concurrent AF.