Abstract T P161: Atrial Fibrillation is Associated With Increased Risk of Silent Cerebral Infarction: A Systematic Review and Meta-analysis
Background: Several studies report an association between atrial fibrillation (AF) and silent cerebral infarcts (SCIs), but no meta-analysis has been done to provide a pooled estimate.
Methods: We searched 5 electronic databases -MEDLINE, PsycINFO, Cochrane Library, CINAHL, and EMBASE- and manually screened bibliographies of pertinent articles. The main outcome of interest was evidence of brain infarcts on imaging or autopsy with no attributable clinical symptoms. Only peer-reviewed prospective and non-prospective studies of patients with no clinical history of stroke or prosthetic valves were included. Random effects meta-analyses using the DerSimonian and Laird method were performed. A sensitivity analysis was carried out restricted to studies which reported adjusted risk estimates. To examine the proportionate excess risk of SCIs associated with AF, we estimated the population-attributable risk (PAR) for each study and reported the pooled PAR.
Results: Of 964 retrieved abstracts, 12 were included (Image). A total of 8461 patients (786 with AF and 7675 without AF) were included in the analysis. 366 (46.56%) patients with AF and 1633 (21.28%) patients without AF had SCIs. AF was significantly associated with SCIs in patients with no clinical stroke history (odds ratio (OR) [95% confidence interval (CI)] = 2.11[1.23, 3.61], I2=80.9%). Pooled PAR [95%CI] was 0.16[0.09, 0.23]. Removing one study at a time did not change the significance of the results or the heterogeneity. The result of the analysis restricted to studies with adjusted ORs remained similar (OR [95% CI] = 2.58 [1.30, 5.14], I2= 73.1%). Among the studies with adjusted ORs, only one included lesions of< 3mm in their definition of SCIs. Removing this study from the secondary analysis eliminated the heterogeneity without changing the results substantially.
Conclusions: AF is associated with a more than twofold increase in the odds of SCI. Similar to clinical stroke, about 16% of SCIs are attributable to AF.
Author Disclosures: S. Kalantarian: None. F.S. Buonanno: None. R. Gollub: None. K. Retzepis: None. M. Mansour: Research Grant; Modest; Boston Scientific, MC10, Biosense Webster, Voyage Medical. Consultant/Advisory Board; Modest; Biosense Webster, St Jude Medical. J.N. Ruskin: Ownership Interest; Modest; Portola, InfoBionic. Consultant/Advisory Board; Modest; Sanofi, CardioInsight, Biosense Webster. Consultant/Advisory Board; Significant; Bristol Myers Squibb, Medtronic, Advanced Medical Education, Pfizer.
- © 2014 by American Heart Association, Inc.