In AF patients on oral anticoagulation, ≥5 deep cerebral microbleeds (aHR 2.87; 95% CI 1.03-8.05), non-lacunar infarcts, and severe intracranial stenosis independently increased ischemic event risk.
Cohort (n=1,019)
Yes
Do baseline neuroimaging markers predict ischemic events in atrial fibrillation patients receiving oral anticoagulation?
In AF patients on oral anticoagulation, baseline neuroimaging markers including ≥5 deep cerebral microbleeds, non-lacunar infarcts, and severe intracranial stenosis independently predict future ischemic events.
Effect estimate: aHR 2.87 (95% CI 1.03-8.05)
Abstract Background and aims Despite oral anticoagulation (OAC), residual risk factors for ischemic stroke in atrial fibrillation (AF) patients remain unclear. We aimed to identify clinical and neuroimaging risk factors for ischemic events in AF patients receiving OAC. Methods We analyzed AF patients receiving OAC from the BAT2 prospective multicenter cohort across 52 hospitals. Baseline brain MRI assessed white matter hyperintensities, cerebral microbleeds (CMBs), lacunes, enlarged perivascular spaces, non-lacunar infarcts, and intracranial arterial stenosis. Cox proportional hazards regression with stepwise selection identified factors associated with ischemic events. Results Of 5,378 patients enrolled, 1,019 AF patients on OAC (80% on DOACs) were included. Among these AF patients, 55 ischemic events occurred during median 2-year follow-up, including 43 ischemic strokes. Compared with non-AF patients (n=4,209), AF patients were older (median: 76 vs. 71 years), had a lower proportion of women (30.5% vs 33.7%), worse renal function, more frequent history of congestive heart failure, and poorer medication adherence. Non-lacunar infarcts were more common in AF patients, whereas lacunes and intracranial stenosis were less common. Independent risk factors for ischemic events were ≥5 deep CMBs (adjusted hazard ratio aHR 2.87, 95%CI 1.03–8.05), non-lacunar infarcts (aHR 2.67, 1.40–5.10), and severe intracranial stenosis (aHR 3.12, 1.23–7.91). For ischemic stroke specifically, ≥5 deep CMBs (aHR 3.94, 1.39–11.23) and non-lacunar infarcts (aHR 2.94, 1.37–6.30) showed similar associations. Conclusions In AF patients receiving OAC, ≥5 deep CMBs, non-lacunar infarcts, and severe intracranial arterial stenosis were associated with increased risk of ischemic events and ischemic stroke. Conflict of interest Soya Iwamoto
Iwamoto et al. (Fri,) conducted a cohort in Atrial fibrillation (n=1,019). Clinical and neuroimaging markers (e.g., deep cerebral microbleeds, non-lacunar infarcts) was evaluated on Ischemic events (aHR 2.87, 95% CI 1.03-8.05). In AF patients on oral anticoagulation, ≥5 deep cerebral microbleeds (aHR 2.87; 95% CI 1.03-8.05), non-lacunar infarcts, and severe intracranial stenosis independently increased ischemic event risk.
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