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. 2024 Jan-Dec:30:10760296241240746.
doi: 10.1177/10760296241240746.

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

Andrea Galeazzo Rigutini  1 ; RAF NOAC Investigators
Collaborators, Affiliations

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

Andrea Galeazzo Rigutini et al. Clin Appl Thromb Hemost. 2024 Jan-Dec.

Abstract

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.

Keywords: aortic plaque; atherosclerosis; atrial fibrillation; internal carotid stenosis; ischemic heart disease; ischemic stroke; peripheral artery disease; stroke.

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Conflict of interest statement

Declaration of Conflicting InterestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Paciaroni received honoraria as a member of the speaker bureau of Aspen, Sanofi-Aventis, Boehringer Ingelheim, Bayer, BMS, Daiichi Sankyo, and Pfizer. Caso received honoraria as a member of the speaker bureau of Boehringer Ingelheim, Bayer, and Daiichi Sankyo (all fees were paid to Associazione Ricerca Stroke, Umbria). She received honoraria as consultant or advisory board member of Boehringer Ingelheim, Bayer, Daiichi Sankyo, and Pfizer. Ntaios received research funding from Pfizer. He received honoraria from Pfizer, Boehringer Ingelheim, and Bayer. He received consultant honoraria from Pfizer, Boehringer Ingelheim, and Bayer. Tsivgoulis has received funding for travel or speaker's honoraria from Bayer, Pfizer, and Boehringer Ingelheim. He has served on scientific advisory boards for Bayer, Boehringer Ingelheim, and Daiichi Sankyo. Putaala has received personal fees from Boehringer Ingelheim, Bayer, and Portola. He has also received grants and personal fees from BMS-Pfizer and Abbott/St Jude Medical. Del Sette has received honoraria for speaking from Bayer and Boehringer Ingelheim. Zedde received speaking and consulting fees from Daiichi Sankyo, Amicus Therapeutics, Sanofi Genzyme, Abbott, and Takeda. Rota has received speaker fees from Bayer and Novartis. Stretz has received departmental funding from Massachusetts General Hospital/Boston Scientific for his site's participation in the Neuro Afib study. Ornello has received nonfinancial support from Novartis, Allergan, and Teva. Ageno has received grants and personal fees from Bayer, personal fees from Boehringer Ingelheim, BMS/Pfizer, Portola, Jansen, Aspen, Sanofi, and Daiichi Sankyo. Sacco has received personal fees as speaker or advisor from Abbott, Allergan, Astra Zeneca, Eli Lilly, Lundbeck, Novartis, NovoNordisk, Teva and research grants from Allergan, Novartis, and Uriach. Giannopoulos has received funding for travel from Bayer and speaker's honoraria from Pfizer. Cappellari has received consulting fees from Boehringer Ingelheim, Pfizer—BMS, and Daiichi Sankyo. Dawson reports honoraria as a member of the speaker bureau of Boehringer Ingelheim, Bayer, BMS, Daiichi Sankyo, Medtronic, and Pfizer. He has also received research funding from Pfizer. Toni has received personal fees from Abbott, Bayer, Boehringer Ingelheim, Daiichi Sankyo, Medtronic, and Pfizer. Agnelli received honoraria as a member of the speaker bureau of Boehringer Ingelheim and Bayer. Becattini received honoraria as a member of the speaker bureau of Bristol Meyer Squibb, Daiichi Sankyo, and Bayer. Michel received Research Grant by Swiss National Science Foundation and Swiss Heart Foundation; he received speaker fees by Bayer, Boehringer Ingelheim, Covidien, St. Jude Medical; he received honoraria as advisory relationship by Pierre-Fabre, Bayer, Bristol Meyer Squibb, Amgen, and Boehringer Ingelheim. Tatlisumak received honoraria as consultant or advisory relationship by Lundbeck and Boehringer Ingelheim. Lip Consultant and speaker for BMS/Pfizer, Boehringer Ingelheim, Daiichi-Sankyo, Anthos. No fees are received personally. GYHL is a National Institute for Health and Care Research (NIHR) Senior Investigator and co-principal investigator of the AFFIRMO project on multimorbidity in AF, which has received funding from the European Union's Horizon 2020 research and innovation program under grant agreement No 899871. The other authors report no conflicts.

Figures

Figure 1.
Figure 1.
Outcomes in patients with atherosclerosis according to the number of atherosclerotic vascular territories involved.
See this image and copyright information in PMC

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