Comparison of Frequency of Ischemic Stroke in Patients With Versus Without Coronary Heart Disease and Without Atrial Fibrillation

Abstract

Recent trials of antithrombotic therapy in patients with CAD have demonstrated substantial reductions in ischemic stroke. Our aim was to examine ischemic stroke risk in patients with CAD and to identify those at highest risk. We examined ischemic stroke risk in patients without AF undergoing coronary angiography (CAG) between 2004 and 2012. Patients were stratified according to presence or absence of CAD and further stratified by extent of CAD (0 VD, 1 VD, 2 VD, 3 VD, and diffuse VD). Endpoints were composites of ischemic stroke, transient ischemic attack (TIA), and systemic embolism, as well as major adverse cardiovascular and cerebrovascular events (MACCE) defined as cardiac death, myocardial infarction, plus ischemic stroke/TIA/systemic embolism. Adjusted incidence rate ratios (IRR) were estimated. A total of 68,829 patients were included, 25,032 had 0 VD, 4,736 had diffuse VD, 18,471 had 1 VD, 10,588 had 2 VD, and 10,002 had 3 VD. Median follow-up was 4.0 years. CAD extent was associated with an increased risk of stroke/TIA/systemic embolism (1VD: adjusted IRR 1.02, 95% CI 0.90-1.16;

Ten-year cardiovascular risk in diabetes patients without obstructive coronary artery disease: a retrospective Western Denmark cohort study

“…Moreover, the 10-year risk of ischemic stroke was higher (5%) than the risk of MI (3%). This is consistent with a recent report that also found that diabetes patients without angiographic CAD were at elevated risk of ischemic stroke [ 13 ]. The control group differed from this study, consisting of non-diabetes patients undergoing CAG [ 13 ].…”

“…This is consistent with a recent report that also found that diabetes patients without angiographic CAD were at elevated risk of ischemic stroke [ 13 ]. The control group differed from this study, consisting of non-diabetes patients undergoing CAG [ 13 ]. These results may reflect thromboembolic events rather than manifestations of carotid and cerebral atherosclerotic disease, which again may be related to a higher prevalence of obesity in patients with diabetes [ 14 ].…”

“…While screening of asymptomatic high-risk diabetes patients is not currently recommended, asymptomatic patients with diabetes duration > 10.5 years may benefit from non-invasive angiographic screening [ 16 , 17 ]. Insulin treatment has also been associated with increased stroke risk and higher mortality [ 13 , 15 , 18 , 19 ]. These associations also apply to diabetes patients without obstructive CAD, as assessed by CAG, compared to the general population.…”

Research update for articles published in EJCI in 2017

“…We have further examined the association between extent of coronary artery disease (CAD) and ischaemic stroke after coronary angiography in a large cohort from Western Denmark. The extent of CAD was associated with an incremental risk of ischaemic stroke and thromboembolism (ischaemic stroke/transient ischaemic attack/systemic embolism) in patients without atrial fibrillation and no previous cerebral ischaemia (n = 68 829) . Obstructive multivessel CAD (2 or 3 vessel disease) was associated with a particularly high thromboembolic risk.…”

“…The extent of CAD was associated with an incremental risk of ischaemic stroke and thromboembolism (ischaemic stroke/transient ischaemic attack/systemic embolism) in patients without atrial fibrillation and no previous cerebral ischaemia (n = 68 829). 72 Obstructive multivessel CAD (2 or 3 vessel disease) was associated with a particularly high thromboembolic risk. In patients with atrial fibrillation (n = 12 690), the presence but not the extent of CAD was associated with increased thromboembolic risk.…”