Central and Branch Retinal Artery Occlusion—Do They Harbor the Same Risk of Further Ischemic Events?

Abstract

Purpose: Retinal artery occlusion (RAO) is associated with an increased risk of cardiovascular events such as ischemic stroke and myocardial infarction, but whether different RAO subtypes such as central retinal artery occlusion (CRAO) or branch retinal artery occlusion (BRAO) carry similar risk of these events is unclear. Our aim was to determine whether the risk of cardiovascular events differs between CRAO and BRAO. Methods: This single-center, retrospective study included 131 patients hospitalized in our clinic in 2010–2020 with CRAO or BRAO confirmed by ophthalmic examination. Data on demographics, previous ischemic stroke and myocardial infarction, comorbidities, the results of echocardiographic and ultrasound carotid artery examinations and laboratory tests were assessed. Data on ischemic stroke, myocardial infarction, and all-cause mortality occurring after RAO were obtained from the Polish National Health Service, which collects data on all publicly funded hospitalizations. Using these data, Kaplan-Meier analyses and Cox proportional hazard regression were performed. Results: Ischemic stroke occurred in 9.9% of patients after RAO: 10.6% in the CRAO group and 8.1% in the BRAO group (p = 0.662). Myocardial infarction occurred in 2.3% of patients after RAO: 2.1% in the CRAO group and 2.7% in the BRAO group (p = 0.843). All-cause mortality occurred in 22.9% of patients after RAO: 25.5% in the CRAO group and 16.2% in the BRAO group (p = 0.253). The composite endpoint of ischemic stroke, myocardial infarction, and all-cause mortality after RAO occurred in 28.2% of patients: 30.9% in the CRAO group and 21.6% in the BRAO group (p = 0.338). There was no difference between CRAO and BRAO in median time to ischemic stroke (32 vs. 76.4 months; p = 0.352), all-cause mortality (35.9 vs. 36.3 months; p = 0.876) or composite endpoint (37.5 vs. 41.5 months; p = 0.912) after RAO. The Kaplan-Meier analysis showed no differences between CRAO and BRAO in ischemic stroke, myocardial infarction, all-cause mortality, or the composite endpoint; similar results were obtained in analyses of patients with and without cardiovascular events before RAO. Conclusions: The prognosis for ischemic stroke, myocardial infarction, and all-cause mortality is similar in patients with CRAO and BRAO. Ischemic strokes occur with a similar frequency before and after RAO. Myocardial infarctions are observed significantly more frequently before an episode of RAO than after. The results of our study indicate that both CRAO and BRAO require expanded diagnostics to assess the risk of recurrent cardiovascular events, especially ischemic strokes, to implement appropriate prophylaxis and reduce mortality.

Retinal Artery Occlusion and Its Impact on the Incidence of Stroke, Myocardial Infarction, and All-Cause Mortality during 12-Year Follow-Up

“…The vast majority of RAO affects elderly patients, in which traditional cardiovascular risk factors have important underlying role in the onset of the disease. The presence of numerous cardiovascular risk factors in patients with RAO has been reported by multiple studies [1][2][3][4][5][6][7][8]10,13,15,18,20,21,24,25]. In a study by Callizo et al, 78% of patients had at least one undiagnosed cardiovascular risk factor at the time of CRAO [3].…”

“…All inpatients treated for RAO (ICD-10: H34.1, H34.9) at the Department of Ophthalmology between 2009 and 2020 were included in this retrospective study. The inclusion of patients with RAO in the study was described previously [ 21 ]. The control group included sex- and age-matched patients without ocular vascular occlusive disorders who were randomly selected from a total of 15,373 patients undergoing cataract surgery between 2009 and 2020 at the Department of Ophthalmology.…”

“…Due to the similarities in pathogenesis and cardiovascular risk factors, an episode of RAO was considered the equivalent of a stroke. As such, it has received considerable attention, especially in the context of subsequent ischemic events [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. To date, there have been only a few large population-based studies assessing the risk of stroke, myocardial infarction, and all-cause mortality in patients with RAO compared with controls [ 10 , 13 , 24 , 25 ].…”

Incidence of Retinal Artery Occlusion and Related Mortality in Korea, 2005 to 2018

“…4,[6][7][8] However, it is unclear whether there is a difference in comorbidities, including cardiovascular diseases, according to RAO subtype, and whether there is a difference in mortality compared with that in the general population. [9][10][11][12] Furthermore, there are few reports on CRAO incidence in large population groups 3,[13][14][15] ; in particular, data on noncentral RAO is scarce, with only one report on annual incidence. 5 Additionally, there are conflicting reports regarding whether CRAO or noncentral RAO is more prevalent.…”

Risk Factors and Treatment Strategy for Retinal Vascular Occlusive Diseases

“…Other studies found that, at least, a new cardiovascular risk factor was found in approximately 80% of patients with CRAO, and carotid stenosis or cardioembolism were observed in approximately 40% of CRAOs [ 42 , 50 ]. Patients with BRAO have a risk of stroke, myocardial infarction, and all-cause mortality comparable to CRAO [ 51 ]. Recent studies investigating the risk factors in CRAO are summarized in Table 1 .…”