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The Impact of Atherosclerotic Burden on Vascular Outcomes in Patients with Stroke and Atrial Fibrillation: The ATHENA study

2024; SAGE Publishing; Volume: 30; Linguagem: Inglês

10.1177/10760296241240746

1938-2723

Andrea Galeazzo Rigutini, Andrea Galeazzo Rigutini, Maurizio Paciaroni, Virginia Cancelloni, Gregory Y.H. Lip, Azmil H. Abdul‐Rahim, Giancarlo Agnelli, Cecilia Becattini, Georgios Tsivgoulis, David Seiffge, Stefan T. Engelter, Philippe Lyrer, Alexandros A. Polymeris, Tolga Dittrich, Annaelle Zietz, Gian Marco De Marchis, Jukka Putaala, Daniel Strbian, Liisa Tomppo, Patrik Michel, Davide Strambo, Alexander Salerno, Peter Vanacker, Susanna M. Zuurbier, Laetitia Yperzeele, Caroline M.J. Loos, Manuel Cappellari, Andrea Emiliani, Marialuisa Zedde, Rosario Pascarella, Jesse Dawson, Robert Cronshaw, Erika Schirinzi, Massimo Del Sette, Christoph Stretz, Narendra Kala, Ashley Schomer, Brian Mac Grory, Mahesh Jayaraman, Shadi Yaghi, Karen L. Furie, Luca Masotti, Elisa Grifoni, Danilo Toni, Angela Risitano, Anne Falcou, Luca Petraglia, Enrico Maria Lotti, Lucia Pavolucci, Piergiorgio Lochner, Giorgio Silvestrelli, Alfonso Ciccone, Andrea Alberti, Michele Venti, Ilaria Leone De Magistris, Maria Giulia Mosconi, Michela Giustozzi, Alessandro Bufi, Agnese Novelli, Odysseas Kargiotis, Alessandro Rocco, Marina Diomedi, Simona Marcheselli, Kateryna Antonenko, Eugenia Rota, Tiziana Tassinari, Valentina Saia, Francesco Palmerini, Paolo Aridon, Valentina Arnao, Serena Monaco, Salvatore Cottone, Antonio Baldi, Cataldo D’Amore, Walter Ageno, Samuela Pegoraro, George Ntaios, Anastasia Adamou, Dimitrios Sagris, Sotirios Giannopoulos, Maria Kosmidou, Evangelos Ntais, Michele Romoli, Leonardo Pantoni, Sílvia Aguiar Rosa, Pierluigi Bertora, Alberto Chiti, Isabella Canavero, Carlo Emanuele Saggese, M Plocco, Elisa Giorli, Lina Palaiodimou, Eleni Bakola, Fabio Bandini, Antonio Gasparro, Valeria Terruso, Marina Mannino, Alessandro Pezzini, Raffaele Ornello, Simona Sacco, Nemanja Popovic, Umberto Scoditti, Antonio Genovese, Licia Denti, Yuriy Flomin, Michelangelo Mancuso, Roberto D’Agliano, Maria Chiara Caselli, Leonardo Ulivi, Nicola Giannini, Kostantinos Vadikolias, Chrysoula Liantinioti, Maria Chondrogianni, Panagiotis Halvatsiotis, Efstathia Karagkiozi, George Athanasakis, Kostantinos Makaritsis, Alessia Lanari, Turgut Tatlisumak, Monica Acciarresi, Gianni Lorenzini, Rossana Tassi, Francesca Guideri, Maurizio Acampa, Giuseppe Martini, Sung‐Il Sohn, Nicola Mumoli, Miriam Maccarrone, Franco Galati, Vanessa Gourbali, Giovanni Orlandi, Martina Giuntini, Francesco Corea, Marta Bellesini, Theodoros Karapanayiotides, László Csiba, L Szabó, Davide Imberti, Dorjan Zabzuni, Alessio Pieroni, Kristian Barlinn, Lars-Peder Pallesen, Jessica Barlinn, Б. М. Доронин, Vera Volodina, Dirk Deleu, Bruno Bonetti, Cesare Porta, Luana Gentile, Giuseppe Reale, Pietro Caliandro, Andrea Morotti, Vieri Vannucchi, Marina Padroni, Federica Letteri, Mauro Magoni, Cindy Tiseo, Alberto Rigatelli, Aurelia Zauli, Valeria Caso,

Cerebrovascular and Carotid Artery Diseases

Introduction: Patients with ischemic stroke (IS) and atrial fibrillation (AF) face a higher risk of recurrent vascular events. This study evaluates the impact of atherosclerotic vascular disease burden across different vascular territories on the risk of vascular events in patients with recent ischemic stroke and AF within 90 days. Patients and Methods: We included patients with IS and AF from the International RAF network in a prospective 90-day follow-up. Atherosclerotic vascular disease was identified by at least one of the following: Symptomatic ischemic heart disease, symptomatic peripheral artery disease, internal carotid stenosis ≥50%, or the presence of plaques in the aorta. The primary outcome was a composite of stroke, transient ischemic attack, systemic embolism, cerebral bleeding, and major extracranial bleeding within 90 days postacute stroke. Patients were categorized into 5 groups based on the number of affected atherosclerotic vascular territories, with those with no atherosclerotic vascular disease as the reference. Kaplan–Meier curves were generated and compared using the log-rank test to determine the predictive value of the number of diseased territories for the risk of events. Data analysis was performed with SPSS/PC Win Package 25.0. Results: Of the 2148 patients (mean age 77.59; 53.86% female), 744 (34.60%) had atherosclerosis. Multivariable analysis revealed that involvement of 3 (hazard ratio [HR] 2.80, 95% confidence interval [CI]: 1.20-6.53) or 4 (HR 6.81, 95% CI: 1.02-36.24) vascular territories was significantly associated with the risk of combined events. Conclusions: In patients with recent ischemic stroke and AF, atherosclerosis across multiple territories correlates with a higher risk of future vascular events.