The impact of atherosclerotic vascular disease in predicting a stroke, thromboembolism and mortality in atrial fibrillation patients: a systematic review

Background Atrial fibrillation (AF) is commonly associated with vascular disease. Although atherosclerotic vascular disease (for example, defined as a myocardial infarction (MI), complex aortic plaque and peripheral arterial disease) has been proposed as a risk factor for a stroke, the co-existence of the two diseases increases the risk of future cardiovascular events. The objective of this study was to conduct a systematic review to assess the impact of atherosclerotic vascular disease on the primary end-point of a stroke, thromboembolism or mortality, in patients with AF. Methods Literature searches were performed electronically, to identify studies published between January 1990and July 2012 examining stroke and thromboembolism in relation to AF and atherosclerotic vascular disease. Nineteen articles satisfied the pre-inclusion criteria. The bibliographies were subsequently screened to retrieve further relevant studies for this review. Results Peripheral arterial disease significantly increased the stroke risk in all 10 observational studies, within a reported risk range of 1.3- to 2.5-fold. Complex aortic plaque on the descending aorta, as identified by trans-oesophageal echocardiography, was also a significant risk factor. Although a prior myocardial infarction (MI) was validated as a significant predictor of the primary end-point amongst five of the six studies, there was a degree of heterogeneity, owing to the marked difference in population sizes and the use of antithrombotic regimens between studies. Conclusion Atherosclerotic vascular disease (e.g. peripheral arterial disease, complex aortic plaque and prior MI) are significant predictors of a stroke, thromboembolism and mortality in subjects with AF.