Coronary angiography in acute ischemic stroke patients: frequency and determinants of pathological findings in a multicenter cohort study

Abstract

Background Myocardial injury as indicated by cardiac troponin elevation is associated with poor prognosis in acute stroke patients. Coronary angiography (CAG) is the diagnostic gold-standard to rule-out underlying obstructive coronary artery disease (CAD) in these patients. However, weighing risks and benefits of coronary angiography (CAG) against each other is particularly challenging, because stroke patients undergoing CAG may have a higher risk for secondary intracranial bleeding. Current guidelines remain vague. Thus, the aim of this study was to analyze frequency of pathological findings of CAG and associated clinical factors. Methods We analyzed indications and frequency of CAG performed in acute ischemic stroke patients in clinical routine in two European tertiary care hospitals from 2011 to 2018. All data were obtained retrospectively. Multiple logistic regression analyses were performed to identify variables associated with absence of obstructive coronary artery disease defined as presence of at least one coronary vessel stenosis ≥ 50%. Results A total of 139 AIS patients underwent CAG. Frequent indications for CAG were suspected acute coronary syndrome (N = 114) or scheduled cardiac surgery (N = 25). Acute coronary stenting was applied in 51/139 patients. Among patients with suspected acute coronary syndrome, no obstructive CAD was found in 27/114 patients. Absence of obstructive CAD was associated with insular cortex lesions, no clinical symptoms for ACS, less than three cardiovascular risk factors, younger age and normal wall motion. Conclusion Several variables suggest absence of CAD in AIS patients and may help in clinical decision making in stroke patients with myocardial injury.

Type 1 Myocardial Infarction in Patients With Acute Ischemic Stroke

“…For example, ischemic brain lesions in the right anterior dorsal insula (representing the central autonomic network) are associated with dynamic hs-cTn elevation. 19,20 On the other hand, 1 in 2 patients with stroke and elevated hs-cTn (ie, myocardial injury) was diagnosed with MI and 1 in 5 with type 1 MI, which is in good agreement with the previous TRELAS study. 17 Thus, our study shows that type 1 MI is a common mechanism of myocardial injury in stroke.…”

“…This phenomenon has recently obtained much attention, giving birth to the term stroke-heart syndrome . For example, ischemic brain lesions in the right anterior dorsal insula (representing the central autonomic network) are associated with dynamic hs-cTn elevation …”