03056nas a2200325 4500008004100000022001400041245013200055210006900187260001300256300001400269490000700283520207500290653002402365653002802389653002102417653001102438653001102449653002002460653000902480653002802489653002402517653001702541653001102558100002702569700001702596700002902613700002702642700002502669856003602694 2023 eng d a1468-133100aHigh-risk carotid plaques and incident ischemic stroke in patients with atrial fibrillation in the Cardiovascular Health Study.0 aHighrisk carotid plaques and incident ischemic stroke in patient c2023 Jul a2042-20500 v303 a

BACKGROUND AND PURPOSE: Whether carotid artery disease could improve stroke risk stratification tools in patients with atrial fibrillation (AF) remains uncertain. This study was undertaken to investigate the risk of ischemic stroke associated with occlusive and nonocclusive carotid atherosclerotic disease in patients with AF in the prospective population-based Cardiovascular Health Study.

METHODS: We included participants aged ≥65 years with AF. We used multivariable Cox regression analysis to explore the risk of ischemic stroke associated with the percentage of carotid stenosis, plaque irregularity, echogenicity, and vulnerability (markedly irregular, ulcerated, or hypoechoic plaques).

RESULTS: A total of 1398 participants were included (55.2% female, 61.7% aged 65-74 years). The maximum carotid stenosis was <50%, 50%-99%, and 100% in 94.5%, 5%, and 0.5% of participants, respectively. High-risk plaques based on echogenicity and plaque irregularity were found in 25.6% and 8.9% of participants, respectively. After a median follow-up of 10.9 years (interquartile range = 7.5-15.6), 298 ischemic strokes were recorded. There was no difference in the incidence of ischemic stroke according to the degree of carotid artery stenosis (p = 0.44), plaque echogenicity (low vs. high risk, p = 0.68), plaque irregularity (low vs. high risk, p = 0.55), and plaque vulnerability (p = 0.86). The CHA₂DS₂-VASc score was associated with an increased risk of ischemic stroke (adjusted hazard ratio = 1.28, 95% confidence interval = 1.18-1.40, p < 0.001). Both maximum grade of stenosis and plaque vulnerability were not associated with incident ischemic stroke (all p > 0.05).

CONCLUSIONS: Neither the degree of carotid stenosis nor the presence of vulnerable plaques was associated with incident ischemic stroke in this cohort of individuals with AF. This suggests that carotid disease was probably not a significant contributor to ischemic stroke in this population.

10aAtrial Fibrillation10aCarotid Artery Diseases10aCarotid Stenosis10aFemale10aHumans10aIschemic Stroke10aMale10aPlaque, Atherosclerotic10aProspective Studies10aRisk Factors10aStroke1 aNoubiap, Jean, Jacques1 aThomas, Gijo1 aKamtchum-Tatuene, Joseph1 aMiddeldorp, Melissa, E1 aSanders, Prashanthan uhttps://chs-nhlbi.org/node/9383