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

IF 2.1 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2026-02-01 Epub Date: 2025-12-19 DOI:10.1016/j.jstrokecerebrovasdis.2025.108532

Kati Lainelehto MD , Juha-Pekka Pienimäki MD, PhD , Sirpa Savilahti MD, PhD , Heini Huhtala MSc , Tomi Sarkanen MD, PhD , Heikki Numminen MD, PhD , Jukka Putaala MD, PhD

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引用次数: 0

Abstract

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.

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脑颈动脉粥样硬化和房颤增加缺血性脑卒中患者的长期死亡率。

背景与目的：心房颤动（AF）和脑供血动脉粥样硬化都是缺血性脑血管事件的重要危险因素。然而，它们同时存在对急性缺血性卒中或短暂性脑缺血发作（TIA）患者长期死亡率的影响研究甚少。方法：对406例急性缺血性脑卒中或TIA患者进行ct血管造影（CTA）检查。以颈动脉、椎动脉和颅内动脉的动脉粥样硬化程度作为颅脑动脉粥样硬化负荷（CAB）评分。此外，我们评估了动脉粥样硬化和房颤的综合影响，包括房颤状态和CAB评分（四分位数）。结果：在中位随访7.3年（四分位数范围5.7-7.6）后，121例AF患者中有62例死亡，而285例非AF患者中有74例死亡（累积死亡率为52.0%，95% CI分别为47.1-56.9%和27.0%,24.7-29.3%）。在校正Cox回归中，CAB评分最高的两个四分位数与AF患者的死亡率相关，风险比分别为12.7（1.6-99.7）和15.8（2.0-126.4）。此外，结合房颤和CAB评分的联合变量，CAB评分最高的两个四分位数的房颤患者的死亡风险是CAB评分最低的两个四分位数的房颤患者的3倍。结论：供脑动脉的总动脉粥样硬化负担似乎是增加急性缺血性卒中或TIA合并AF患者长期死亡率的一个强有力的独立因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.