Meta-Analysis Comparing the Frequency of Carotid Artery Stenosis in Patients With Atrial Fibrillation and Vice Versa

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Atrial fibrillation (AF) and carotid stenosis (CS) can coexist and this association has been reported to result in a higher risk of stroke than attributed to either condition alone. Here we aimed to summarize the data on the association of CS and AF. MEDLINE and Embase were searched to identify all published studies providing relevant data through February 27, 2020. Random-effects meta-analysis method was used to pool estimates of prevalence. Heterogeneity was assessed by mean I-squared statistic. Forty-eight studies were included, 20 reporting on the prevalence of carotid disease in a pooled population of 49,070 AF patients, and 28 on the prevalence of AF in a total of 2,288,265 patients with carotid disease. The pooled prevalence of CS in AF patients was 12.4% (95% confidence interval [CI] 8.7 to 16.0, I2 93%; n = 3,919), ranging from 4.4% to 24.3%. The pooled prevalence of carotid plaque was 48.4% (95% CI 35.2 to 61.7, I2 = 99%; n = 4292). The prevalence of AF in patients with CS was 9.3% (95% CI 8.7 to 10.0, I2 99%; n = 2,286,518), ranging from 3.6% to 10.0%. This prevalence was much higher (p <0.001) in patients undergoing carotid artery stenting (12.7%, 95% CI 11.3 to 14.02, I2 38.3%) compared with those undergoing carotid endarterectomy (6.9%, 95% CI 8.3 to 10.4, I2 94.1%). There was no difference in AF prevalence between patients with CS, with and without previous cerebrovascular event (p >0.05). In conclusion, AF and CS frequently coexist, with about one in ten patients with AF having CS, and vice versa. In addition, nonstenotic carotid disease is present in about half of AF patients. These findings have important implications for AF screening in patients with CS, stroke prevention, and the opportunities to intervene on common risk factors.

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Methods

PubMed/MEDLINE, Excerpta Medica Database (EMBASE), and Web of Science were searched to identify all studies reporting primary data of the prevalence of CS in AF patients, and of AF in patients with CS or CP, published until February 27, 2020, irrespective of the language. The search strategy was built based on the combination of relevant terms including “carotid artery stenosis,” “atrial fibrillation,” and their bibliographic synonyms (Supplementary Table 1). Furthermore, the reference list of

Results

In total, we identified 6,202 records among which 46 articles were finally included,5,6,9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52 providing data for 48 studies (Figure 1). Of the included studies, 20 reported on the prevalence of carotid disease from a pooled population of 49,070 AF patients.5,6,37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52 Studies

Discussion

According to recent data, carotid stenosis doubles the risk of stroke in AF patients, after adjustment for classical clinical risk factors and antithrombotic therapy (8.1 vs 3.6 events/100 follow-up years; p = 0.005).5 Our study suggests that about 12% of patients with AF have significant CS (≥50%), with prevalence rates reaching about 25% in some settings. This means that, considering the significant prevalence of CS in AF patients, along with its high attributed stroke risk, CS should be a

Disclosures

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Credit Author Statement

Jean Jacques Noubiap: Conception and design, search strategy, study selection, data extraction, data synthesis, data interpretation, manuscript drafting, manuscript revision, approval of the final manuscript.

Thomas A. Agbaedeng: Study selection, data synthesis, data interpretation, manuscript drafting, manuscript revision, approval of the final manuscript.

Joel Noutakdie Tochie: Data extraction, manuscript revision, approval of the final manuscript.

Jan René Nkeck: Study selection, data

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    Availability of data and material: All data generated or analyzed during this study are included in this published article and its supplementary information files.

    Funding: This study received no funding.

    Financial disclosures: Dr Noubiap and Fitzgerald are supported by a Postgraduate Scholarship from the University of Adelaide. Dr Agbaedeng and Middeldorp are supported by Postdoctoral Fellowship from the University of Adelaide. Dr Sanders is supported by a Practitioner Fellowships from the National Health and Medical Research Council of Australia and by the National Heart Foundation of Australia.

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