The Impact of Atherosclerotic Burden on Vascular Outcomes in Patients with Stroke and Atrial Fibrillation: The ATHENA study
Authors: Rigutini Andrea Galeazzo ,   RAF NOAC Investigators, Rigutini Andrea Galeazzo , Paciaroni Maurizio , Cancelloni Virginia , Lip Gregory Y.H. , Abdul-Rahim Azmil , Agnelli Giancarlo , Becattini Cecilia , Tsivgoulis Georgios , Seiffge David Julian , Engelter Stefan T. , Lyrer Philippe , Polymeris Alexandros A. , Dittrich Tolga , Zietz Annaelle , De Marchis Gian Marco , Putaala Jukka , Strbian Daniel , Tomppo Liisa , Michel Patrik , Strambo Davide , Salerno Alexander , Vanacker Peter , Zuurbier Susanna , Yperzeele Laetitia , Loos Caroline M.J. , Cappellari Manuel , Emiliani Andrea , Zedde Marialuisa , Pascarella Rosario , Dawson Jesse , Cronshaw Robert , Schirinzi Erika , Sette Massimo Del , Stretz Christoph , Kala Narendra , Schomer Ashley , Grory Brian Mac , Jayaraman Mahesh , Yaghi Shadi , Furie Karen L. , Masotti Luca , Grifoni Elisa , Toni Danilo , Risitano Angela , Falcou Anne , Petraglia Luca , Lotti Enrico Maria , Pavolucci Lucia , Lochner Piergiorgio , Silvestrelli Giorgio , Ciccone Alfonso , Alberti Andrea , Venti Michele , De Magistris Ilaria Leone , Mosconi Maria Giulia , Giustozzi Michela , Bufi Alessandro , Novelli Agnese , Kargiotis Odysseas , Rocco Alessandro , Diomedi Marina , Marcheselli Simona , Antonenko Kateryna , Rota Eugenia , Tassinari Tiziana , Saia Valentina , Palmerini Francesco , Aridon Paolo , Arnao Valentina , Monaco Serena , Cottone Salvatore , Baldi Antonio , D’Amore Cataldo , Ageno Walter , Pegoraro Samuela , Ntaios George , Adamou Anastasia , Sagris Dimitrios , Giannopoulos Sotirios , Kosmidou Maria , Ntais Evangelos , Romoli Michele , Pantoni Leonardo , Rosa Silvia , Bertora Pierluigi , Chiti Alberto , Canavero Isabella , Saggese Carlo Emanuele , Plocco Maurizio , Giorli Elisa , Palaiodimou Lina , Bakola Eleni , Bandini Fabio , Gasparro Antonio , Terruso Valeria , Mannino Marina , Pezzini Alessandro , Ornello Raffaele , Sacco Simona , Popovic Nemanja , Scoditti Umberto , Genovese Antonio , Denti Licia , Flomin Yuriy , Mancuso Michelangelo , D’Agliano Roberto , Caselli Maria Chiara , Ulivi Leonardo , Giannini Nicola , Vadikolias Kostantinos , Liantinioti Chrysoula , Chondrogianni Maria , Halvatsiotis Panagiotis , Karagkiozi Efstathia , Athanasakis George , Makaritsis Kostantinos , Lanari Alessia , Tatlisumak Turgut , Acciarresi Monica , Lorenzini Gianni , Tassi Rossana , Guideri Francesca , Acampa Maurizio , Martini Giuseppe , Sohn Sung-Il , Mumoli Nicola , Maccarrone Miriam , Galati Franco , Gourbali Vanessa , Orlandi Giovanni , Giuntini Martina , Corea Francesco , Bellesini Marta , Karapanayiotides Theodore , Csiba Laszló , Szabó Lilla , Imberti Davide , Zabzuni Dorjan , Pieroni Alessio , Barlinn Kristian , Pallesen Lars-Peder , Barlinn Jessica , Doronin Boris , Volodina Vera , Deleu Dirk , Bonetti Bruno , Porta Cesare , Gentile Luana , Reale Giuseppe , Caliandro Pietro , Morotti Andrea , Vannucchi Vieri , Padroni Marina , Letteri Federica , Magoni Mauro , Tiseo Cindy , Rigatelli Alberto , Zauli Aurelia , Caso Valeria 
Published: April 2024

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.