Incidental Coronary Artery Calcification and Stroke Risk in Patients With Atrial Fibrillation

Hillerson, Dustin; Wool, Thomas; Ogunbayo, Gbolahan; Sorrell, Vincent L.; Leung, Steve W.

doi:10.2214/ajr.19.22298

Cited by 19 publications

(11 citation statements)

References 20 publications

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“…In the study by Tagawa and colleagues, asymptomatic CAD was identified with a positive myocardial scintigraphy test in a quarter of patients with ischemic strokes 33 . Conversely, the reverse has also been described with inconclusive evidence for CAD as an independent risk factor for stroke, consistent with our findings 34,35 …”

Section: Discussionsupporting

confidence: 89%

“…33 Conversely, the reverse has also been described with inconclusive evidence for CAD as an independent risk factor for stroke, consistent with our findings. 34,35 Much of the CAD group in our study comprised of patients with angina who may not have had an angiogram, meaning they may not fall under the strict definition of "angiographically significant CAD" that forms part of the CHA 2 DS 2 VASc score. This may also explain why prior MI but not angina was associated with a significantly elevated risk of the composite outcomes and all-cause death in the sub-analysis of the CAD group.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes in elderly Chinese patients with atrial fibrillation and coronary artery disease. A report from the Optimal Thromboprophylaxis in Elderly Chinese Patients with Atrial Fibrillation (ChiOTEAF) registry

Kotalczyk

Guo

Fawzy

et al. 2022

Journal of Arrhythmia

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Background Atrial fibrillation (AF) and coronary artery disease (CAD) are closely related; CAD may precede or complicate the clinical course of AF. Objective To evaluate the impact of CAD on clinical outcomes among elderly Chinese AF patients. Methods The ChiOTEAF registry is a prospective registry conducted in 44 sites from 20 provinces in China between October 2014 and December 2018. Primary outcome was the composite of all‐cause mortality/any thromboembolism (TE)/major bleeding/acute coronary syndrome (ACS). Results The eligible cohort for this analysis included 6403 individuals (mean age 74.8 ± 10.7; 39.2% female); of these, 3058 (47.8%) had a history of CAD. On multivariate analysis, CAD was independently associated with a higher odds ratio for ACS (OR: 1.98; 95% CI: 1.12–3.52) without a significant impact on other adverse outcomes. Independent variables associated with the composite outcome among CAD patients were: (i) the use of OAC (OR: 0.55; 95% CI: 0.42–0.72), age (OR: 1.09; 95% CI: 1.08–1.11), heart failure (OR: 1.95; 95% CI: 1.51–2.50), prior ischemic stroke (OR: 1.29; 95% CI: 1.02–1.64), chronic kidney disease (OR: 1.71; 95% CI: 1.32–2.22), and chronic obstructive pulmonary disease (OR: 1.42; 95% CI: 1.06–1.89). Conclusions AF patients with CAD were at an increased risk of developing ACS but there was no significant difference in the composite outcome, all cause death, cardiovascular death, thromboembolic events or major bleeding compared to the non‐CAD group. OAC use was inversely associated with adverse events, yet their uptake was poor in the AF‐CAD population.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Outcomes in elderly Chinese patients with atrial fibrillation and coronary artery disease. A report from the Optimal Thromboprophylaxis in Elderly Chinese Patients with Atrial Fibrillation (ChiOTEAF) registry

Kotalczyk

Guo

Fawzy

et al. 2022

Journal of Arrhythmia

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“… 2 Arterial calcification in patients with stroke increases the risk of atherosclerotic stroke independent of age, sex, and atrial fibrillation. 3 , 4 Intracranial calcification is associated with the early progression or recurrence of stroke, coronary events, vascular deaths, 5 and hemorrhagic transformation in patients with noncardioembolic stroke. 6 Vertebrobasilar calcification in patients with ischemic stroke is a valid predictor for stroke recurrence and acute vascular disease.…”

mentioning

confidence: 99%

“… 6 Vertebrobasilar calcification in patients with ischemic stroke is a valid predictor for stroke recurrence and acute vascular disease. 7 Coronary artery calcification in patients with atrial fibrillation has increased the independent risk of stroke, 3 but carotid calcification is not associated with incident stroke. 8 …”

mentioning

confidence: 99%

Carotid Siphon Calcification Predicts the Symptomatic Progression in Branch Artery Disease With Intracranial Artery Stenosis—Brief Report

Hou

Yang

Wang

et al. 2022

ATVB

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Background: Arterial calcification in the aortic arch, carotid bifurcation, or siphon on computed tomography was associated with cardiovascular disease. The association between arterial calcification prevalence and progression of branch atheromatous disease (BAD) in intracranial artery atherosclerosis was little investigated. Methods: This study included 310 patients with ischemic stroke from one stroke center. Patients were divided into BAD (110) and non-BAD groups (200). Baseline characteristics, lipids, and arterial calcification were measured. The primary outcome was the prevalence of arterial calcification in BAD progression, and the secondary outcome was the prevalence of calcification in arterial stenosis. The association or correlation among calcification prevalence, lipid markers, and BAD progression was analyzed using logistic regression, receiver operating characteristic curve, and linear regression. Results: Our study found that carotid siphon calcification on computed angiography was more prevalent ( P =0.01) in patients with BAD and also more prevalent ( P <0.001) in intracranial artery stenosis, and its computed tomography values could independently predict the symptomatic progression ( P =0.01). Furthermore, a strong linear correlation between oxidized lipid and calcification density was found (beta=−0.73, P =0.0048) in patients with BAD, a subtype (B-type) of intracranial arterial atherosclerotic disease. Conclusions: We found that carotid siphon calcification was associated with BAD and its computed tomography values could predict the symptomatic progression in patients with intracranial arterial atherosclerotic disease and BAD, indicating the important role of carotid calcification in B-type intracranial arterial atherosclerotic disease. REGISTRATION: URL: http://www.chictr.org.cn ; Unique identifier: ChiCTR1800018315

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“…Incorporating CAC into the Framingham stroke risk score could improve the discrimination for cerebrovascular events ( Gibson et al, 2014 ). In 2020, research showed that atrial fibrillation (AF) patients with incidental CAC depicted on chest CT had an increased risk of stroke and mortality beyond established risk factors ( Hillerson et al, 2020 ), which is also supported by a recent study ( Wang et al, 2021 ). In a study combining two large cohorts, a high CAC burden was predictive of stroke risk in the overall cohort and Blacks ( Mehta et al, 2020 ).…”

Section: Coronary Artery Calcificationmentioning

confidence: 80%

Arterial Calcification and Its Association With Stroke: Implication of Risk, Prognosis, Treatment Response, and Prevention

Wang

Chen

et al. 2022

Front. Cell. Neurosci.

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Stroke is a leading cause of death worldwide. Vascular calcification (VC), defined as deposition of calcium-phosphate complexes in the vessels, is considered as the characteristic of vascular aging. Calcifications at different vessel layers have different implications. Intimal calcification is closely related to atherosclerosis and affects plaque stability, while medial calcification can cause arterial stiffening and reduce compliance. Accumulating evidence suggested that arterial calcifications, including calcifications in the intracranial artery, coronary artery, and carotid artery, are associated with the risk, prognosis, and treatment response of stroke. VC can not only serve as a marker of atherosclerosis, but cause cerebral hemodynamic impairment. In addition, calcifications in large arteries are associated with cerebral small vessel disease. In this review, we summarize the findings of recently published studies focusing on the relationship between large artery calcification and the risk, prognosis, treatment response, and prevention of stroke and also discuss possible mechanisms behind those associations.

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Incidental Coronary Artery Calcification and Stroke Risk in Patients With Atrial Fibrillation

Cited by 19 publications

References 20 publications

Outcomes in elderly Chinese patients with atrial fibrillation and coronary artery disease. A report from the Optimal Thromboprophylaxis in Elderly Chinese Patients with Atrial Fibrillation (ChiOTEAF) registry

Outcomes in elderly Chinese patients with atrial fibrillation and coronary artery disease. A report from the Optimal Thromboprophylaxis in Elderly Chinese Patients with Atrial Fibrillation (ChiOTEAF) registry

Carotid Siphon Calcification Predicts the Symptomatic Progression in Branch Artery Disease With Intracranial Artery Stenosis—Brief Report

Arterial Calcification and Its Association With Stroke: Implication of Risk, Prognosis, Treatment Response, and Prevention

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