Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia.
Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia.
Am J Cardiol. 2021 Jan 1;138:72-79. doi: 10.1016/j.amjcard.2020.10.017. Epub 2020 Oct 13.
Atrial fibrillation (AF) and carotid stenosis (CS) can coexist and this association has been reported to result in a higher risk of stroke than attributed to either condition alone. Here we aimed to summarize the data on the association of CS and AF. MEDLINE and Embase were searched to identify all published studies providing relevant data through February 27, 2020. Random-effects meta-analysis method was used to pool estimates of prevalence. Heterogeneity was assessed by mean I-squared statistic. Forty-eight studies were included, 20 reporting on the prevalence of carotid disease in a pooled population of 49,070 AF patients, and 28 on the prevalence of AF in a total of 2,288,265 patients with carotid disease. The pooled prevalence of CS in AF patients was 12.4% (95% confidence interval [CI] 8.7 to 16.0, I 93%; n = 3,919), ranging from 4.4% to 24.3%. The pooled prevalence of carotid plaque was 48.4% (95% CI 35.2 to 61.7, I = 99%; n = 4292). The prevalence of AF in patients with CS was 9.3% (95% CI 8.7 to 10.0, I 99%; n = 2,286,518), ranging from 3.6% to 10.0%. This prevalence was much higher (p <0.001) in patients undergoing carotid artery stenting (12.7%, 95% CI 11.3 to 14.02, I 38.3%) compared with those undergoing carotid endarterectomy (6.9%, 95% CI 8.3 to 10.4, I 94.1%). There was no difference in AF prevalence between patients with CS, with and without previous cerebrovascular event (p >0.05). In conclusion, AF and CS frequently coexist, with about one in ten patients with AF having CS, and vice versa. In addition, nonstenotic carotid disease is present in about half of AF patients. These findings have important implications for AF screening in patients with CS, stroke prevention, and the opportunities to intervene on common risk factors.
心房颤动（AF）和颈动脉狭窄（CS）可以并存，这种并存会导致中风风险高于单一疾病的风险。在这里，我们旨在总结 CS 和 AF 并存的数据。通过 2020 年 2 月 27 日检索 MEDLINE 和 Embase 数据库，以确定所有提供相关数据的已发表研究。采用随机效应荟萃分析方法汇总患病率的估计值。通过平均 I 平方统计量评估异质性。共纳入 48 项研究，其中 20 项研究报告了在共纳入 49070 例 AF 患者的人群中颈动脉疾病的患病率，28 项研究报告了在共纳入 2288265 例颈动脉疾病患者中 AF 的患病率。AF 患者 CS 的患病率为 12.4%（95%置信区间[CI]8.7%至 16.0%，I 93%；n=3919），范围为 4.4%至 24.3%。颈动脉斑块的患病率为 48.4%（95% CI 35.2%至 61.7%，I 99%；n=4292）。CS 患者中 AF 的患病率为 9.3%（95% CI 8.7%至 10.0%，I 99%；n=2286518），范围为 3.6%至 10.0%。在接受颈动脉支架置入术的患者中，该患病率更高（12.7%，95% CI 11.3%至 14.02%，I 38.3%），明显高于接受颈动脉内膜切除术的患者（6.9%，95% CI 8.3%至 10.4%，I 94.1%）（p<0.001）。CS 患者中，无论是否有过脑血管事件，AF 的患病率无差异（p>0.05）。总之，AF 和 CS 经常并存，大约每 10 例 AF 患者中就有 1 例患有 CS，反之亦然。此外，约有一半的 AF 患者存在非狭窄性颈动脉疾病。这些发现对 CS 患者的 AF 筛查、中风预防以及干预共同危险因素的机会具有重要意义。
