The impact of atherosclerotic vascular disease in predicting stroke, thromboembolism and mortality in atrial fibrillation patients: A systematic review.
J Thromb Haemost. 2013 Feb 27;
Authors: Anandasundaram B, Lane D, Apostolakis S, Lip GY
BACKGROUND: Atrial fibrillation (AF) is commonly associated with vascular disease. Although atherosclerotic vascular disease (for example, defined as myocardial infarction (MI), complex aortic plaque and peripheral arterial disease) has been proposed as a risk factor for stroke, the co-existence of the two diseases increases the risk of future cardiovascular events. Our objective was to conduct a systematic review to assess the impact of atherosclerotic vascular disease on the primary end-point of stroke, thromboembolism or mortality, in patients with AF. METHODS: Literature searches were performed electronically, to identify studies published between January 1990and July 2012 examining stroke and thromboembolism in relation to AF and atherosclerotic vascular disease. Nineteen articles satisfied the pre-inclusion criteria. The bibliographies were subsequently screened to retrieve further relevant studies for this review. RESULTS: Peripheral arterial disease significantly increased the stroke risk in all ten observational studies, within a reported risk range of 1.3 to 2.5-fold. Complex aortic plaque on the descending aorta, as identified by trans-oesophageal echocardiography, was also a significant risk factor. Although prior myocardial infarction (MI) was validated as a significant predictor of the primary end-point amongst five of the six studies, there was a degree of heterogeneity, owing to the marked difference in population sizes and use of antithrombotic regimens between studies. CONCLUSION: Atherosclerotic vascular disease (eg. peripheral arterial disease, complex aortic plaque and prior MI) are significant predictors of stroke, thromboembolism and mortality in subjects with AF. © 2013 International Society on Thrombosis and Haemostasis.
PMID: 23441593 [PubMed - as supplied by publisher]