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June 27, 2026EP EuropaceOpen Access

Severe coronary artery stenosis linked to ~52% higher 3-year ischemic stroke risk in AF.

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Why the study?

Evidence for defining significant CAD or its extent in the CHA2DS2-VASc score is weak and derived only from a Danish population.

Does severe coronary artery stenosis predict an increased risk of ischemic stroke compared to non-severe stenosis in patients with atrial fibrillation without prior clinical coronary artery disease?

Population

2,898 AF patients without history of CAD who underwent cardiac CT or invasive coronary angiography

Comparison

Coronary artery stenosis severity: severe (≥70%) vs moderate (50–69%) vs mild (1–49%) vs none (0%)

Design

Observational cohort study with inverse probability weighting

Follow-up

3 years

Key result

Severe coronary artery stenosis (≥70%) was an independent predictor of 3-year ischemic stroke in patients with atrial fibrillation (HR 1.52; 95% CI 1.15-2.01; p=0.003).

Authors

KLK H LeeCKC H KimYLY H Lee

Discussion

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Overview

Elevates ischemic stroke risk; confirms the association in this randomized cohort.

Key Points

  • This study aims to validate the relationship between the extent of coronary artery disease and ischemic stroke risk in patients with atrial fibrillation.
  • Analysis included 2,898 patients with atrial fibrillation with no prior coronary artery disease history.
  • Patients underwent cardiac computed tomography or invasive coronary angiography.
  • Cox hazards models estimated stroke risks based on coronary stenosis severity over a 3-year period.
  • Incidence of ischemic stroke increased with stenosis severity: none 5.8%, mild 4.6%, moderate 6.3%, severe 7.3% (trend p=0.007).
  • Severe coronary stenosis (≥70%) was an independent predictor of stroke, with HR 1.52 (95% CI, 1.15–2.01; p=0.003).
  • Adjusted HRs indicated that coronary stenosis less than 70% may not be useful for stroke risk prediction.

Study Design

Type

Cohort (n=2,898)

Structured PICO

Does severe coronary artery stenosis predict an increased risk of ischemic stroke compared to non-severe stenosis in patients with atrial fibrillation without prior clinical coronary artery disease?

P
Population
2,898 patients with atrial fibrillation and no history of myocardial infarction, angina, or previous percutaneous coronary intervention, followed for 3 years.
E
Exposure
Severe coronary artery stenosis (≥70%)
C
Comparator
None (0%), mild (1–49%), and moderate (50–69%) coronary artery stenosis
O
Outcome
Incidence of ischemic stroke within 3 years after baselinehard clinical

Main Result

Hazard Ratio: 1.52 (95% CI 1.15–2.01)

Absolute Event Rate: 7.3% vs 5.8%

p-value: p=0.003

In patients with atrial fibrillation and no prior clinical CAD, only severe coronary stenosis (≥70%) independently predicts ischemic stroke, suggesting lesser degrees of stenosis may not add value to stroke risk stratification.

Limitations

  • External validation is warranted

Cite This Study

Lee et al. (2026) conducted a cohort in Atrial fibrillation (n=2,898). Severe coronary artery stenosis (≥70%) vs. No coronary stenosis (0%) was evaluated on Incidence of ischemic stroke within 3 years (HR 1.52, 95% CI 1.15-2.01, p=0.003). Severe coronary artery stenosis (≥70%) was an independent predictor of 3-year ischemic stroke in patients with atrial fibrillation (HR 1.52; 95% CI 1.15-2.01; p=0.003).

synapsesocial.com/papers/6a3f97bb125782b61d865920https://doi.org/10.1093/europace/euag105.347
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