Meta-Analysis Comparing the Frequency of Carotid Artery Stenosis in Patients With Atrial Fibrillation and Vice Versa
Section snippets
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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Cited by (11)
Screening for asymptomatic carotid stenosis in patients with non-valvular atrial fibrillation
2023, International Journal of CardiologyEditor's Choice – European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on the Management of Atherosclerotic Carotid and Vertebral Artery Disease
2023, European Journal of Vascular and Endovascular SurgeryCitation Excerpt :No other international guidelines have provided any recommendations regarding the optimal management of ocular ischaemia syndrome. A 2021 meta-analysis (20 observational studies) reported that 12% of AF patients had a > 50% carotid stenosis, while in 25 observational studies, 9% of patients with > 50% carotid stenosis had AF.84 This suggests that about one in 10 patients with > 50% carotid stenosis will have AF and vice versa.
Stroke risk associated with carotid and aortic atherosclerosis in patients with atrial fibrillation: A systematic review
2021, Journal of the Neurological SciencesCitation Excerpt :A recent meta-analysis showed that AF and carotid stenosis frequently coexist, with about one in ten patients with AF having carotid stenosis, and vice versa. Furthermore, about half of patients with AF have non-stenotic carotid disease [3]. Interestingly, severe carotid stenosis accounted for about one fourth of ischemic strokes in a cohort of 103 patients with AF [4].
The Reply
2021, American Journal of MedicineHigh-risk carotid plaques and incident ischemic stroke in patients with atrial fibrillation in the Cardiovascular Health Study
2023, European Journal of Neurology
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.