Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, Utah; Department of Internal Medicine, Stanford University, Palo Alto, California.
Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, Utah.
Heart Rhythm. 2020 Jan;17(1):20-26. doi: 10.1016/j.hrthm.2019.07.007. Epub 2019 Jul 9.
Patients with carotid arterial disease (CD) with and without atrial fibrillation (AF) are at risk of stroke. Patients with AF are at a higher risk of stroke and dementia.
We sought to understand the risks of stroke, transient ischemic attack (TIA), and dementia in patients with and without AF and CD or a combination of both as well as to determine whether therapies for each disease may influence risks.
A total of 11,572 patients were included in 4 groups, with 2893 patients populating each group (1: no AF or CD; 2: AF, no CD; 3: CD and no AF; 4: AF and CD) and matched for age, sex, and comorbidities. Long-term outcomes of stroke/TIA and dementia were assessed. Subset analyses of these outcomes were performed in patients with CD treated with revascularization and in patients with AF treated with ablation.
CD increased the risk of stroke/TIA (hazard ratio [HR] 2.74; P < .0001) and dementia (HR 1.44; P < .0001). Similarly, AF increased the risk of stroke/TIA (HR 2.08; P < .0001) and dementia (HR 1.30; P = .004). The coexistence of AF and CD further augmented the risk of both end points. CD revascularization was associated with a decreased risk of dementia (HR 0.47; P < .0001) but not stroke. Ablation of AF improved outcomes of stroke/TIA (HR 0.55; P = .002), particularly in those with CD (HR 0.36; P < .0001), and was associated with a reduced risk of dementia (HR 0.51; P = .04).
CD and AF augment risk of stroke/TIA and dementia in the general population, and the coexistence of both diseases is additive in risk. Ablation of AF was associated with lower risk, the magnitude of which was greater in those with CD.
患有颈动脉疾病（CD）和/或心房颤动（AF）的患者有发生中风的风险。患有 AF 的患者中风和痴呆的风险更高。
我们旨在了解患有 AF 和 CD 或两者兼有以及无 AF 和 CD 的患者发生中风、短暂性脑缺血发作（TIA）和痴呆的风险，并确定针对每种疾病的治疗是否会影响风险。
共有 11572 名患者分为 4 组，每组 2893 名患者（1：无 AF 或 CD；2：AF，无 CD；3：CD 且无 AF；4：AF 和 CD），并按年龄、性别和合并症进行匹配。评估中风/TIA 和痴呆的长期结局。对接受血运重建治疗的 CD 患者和接受消融治疗的 AF 患者进行这些结局的亚组分析。
CD 增加了中风/TIA（风险比 [HR] 2.74；P<0.0001）和痴呆（HR 1.44；P<0.0001）的风险。同样，AF 增加了中风/TIA（HR 2.08；P<0.0001）和痴呆（HR 1.30；P=0.004）的风险。AF 和 CD 的共存进一步增加了这两个终点的风险。CD 血运重建与痴呆风险降低相关（HR 0.47；P<0.0001），但与中风无关。AF 的消融改善了中风/TIA 的结局（HR 0.55；P=0.002），尤其是在 CD 患者中（HR 0.36；P<0.0001），并与痴呆风险降低相关（HR 0.51；P=0.04）。
CD 和 AF 增加了一般人群中风/TIA 和痴呆的风险，两种疾病的共存会增加风险。AF 的消融与较低的风险相关，在患有 CD 的患者中，这种相关性更强。
