Thoracic aortic aneurysm and atrial fibrillation: clinical associations with the risk of stroke from a global federated health network analysis

Riccardo Proietti, José Miguel Rivera-Caravaca, Stephanie Lucy Harrison, Benjamin James Roy Buckley, Raquel López-Gálvez, Francisco Marín, Timothy Fairbairn, Jillian Madine, Riaz Akhtar, Paula Underhill, Mark Field, Gregory Yoke Hong Lip

Research output: Contribution to journalArticlepeer-review


Background: An association with aortic aneurysm has been reported among patients with atrial fibrillation (AF). The aims of this study were to investigate the prevalence of thoracic aorta aneurysm (TAA) among patients with AF and to assess whether the co-presence of TAA is associated with a higher risk of adverse clinical outcomes. Methods and results: Using TriNetX, a global federated health research network of anonymised electronic medical records, all adult patients with AF, were categorised into two groups based on the presence of AF and TAA or AF alone. Between 1 January 2017 and 1 January 2019, 874,212 people aged ≥ 18 years with AF were identified. Of these 17,806 (2.04%) had a TAA. After propensity score matching (PSM), 17,805 patients were included in each of the two cohorts. During the 3 years of follow-up, 3079 (17.3%) AF patients with TAA and 2772 (15.6%) patients with AF alone, developed an ischemic stroke or transient ischemic attack (TIA). The risk of ischemic stroke/TIA was significantly higher in patients with AF and TAA (HR 1.09, 95% CI 1.04–1.15; log-rank p value < 0.001) The risk of major bleeding was higher in patients with AF and TAA (OR 1.07, 95% CI 1.01–1.14), but not significant in time-dependent analysis (HR 1.04, 95% CI 0.98–1.10; log-rank p value = 0.187), Conclusion: This retrospective analysis reports a clinical concomitance of the two medical conditions, and shows in a PSM analysis an increased risk of ischemic events in patients affected by TAA and AF compared to AF alone.

Original languageEnglish
Pages (from-to)423-428
Number of pages6
JournalInternal and Emergency Medicine
Issue number2
Publication statusPublished or Issued - Mar 2023
Externally publishedYes


  • Atrial fibrillation
  • Risk factors
  • Stroke
  • Thoracic aortic aneurysm

ASJC Scopus subject areas

  • Internal Medicine
  • Emergency Medicine

Cite this