Coronary Artery Calcium Score Improves the Prediction of Occult Coronary Artery Stenosis in Ischemic Stroke Patients

Abstract

BackgroundCoronary heart disease is a significant cause of morbidity and mortality in stroke patients. The coronary artery calcium score (CACS) has emerged as a robust and noninvasive predictor of coronary events. We assessed the predictive ability of CACS to identify stroke patients with severe (≥50%) occult coronary artery stenosis in a stroke/transient ischemic attack population, in addition to the PRECORIS score, based on Framingham Risk Score and presence of cervicocephalic artery stenosis, which was derived and validated for that purpose.Methods and ResultsWe enrolled consecutive patients aged 45 to 75 years referred to our stroke unit with noncardioembolic ischemic stroke or transient ischemic attack, and no prior history of coronary disease. The presence of coronary stenosis was assessed with 64‐section computed tomography coronary angiography, and all patients had a detailed etiological work‐up. CACS was determined from computed tomography measurement using the Agatson score. The predictive value of CACS was assessed by logistic regression and reclassification method. Among 300 patients included in the study, 274 had computed tomography coronary angiography. Fifty patients (18%) had at least 1 coronary artery stenosis ≥50%. In multivariable analysis, after adjustment for the PRECORIS score, CACS was strongly associated with the presence of occult coronary artery stenosis (odds ratio=14.8 [1.8–120.3] for CACS [1–100] and 70.9 [8.9–562.0] for CACS >100). When CACS was added to the standard model, model fit was improved (P<0.001), Net Reclassification Improvement was 28.2% (P<0.001), and Integrated Discrimination Index was 18.2% (P<0.001).ConclusionsIn stroke/transient ischemic attack patients, CACS improves the prediction of occult coronary stenosis beyond classical risk factors.

Relationship Between Sleep Apnea and Coronary Artery Calcium in Patients With Ischemic Stroke

“…Sleep apnea, a potential risk factor for CAD, could be used for predicting the presence of hidden CAD. However, previous studies have not investigated the relationship between the CAC score and OSA (7, 8, 22). One study with a large sample size examined the relationship between OSA and CAC in otherwise healthy subjects, including individuals with obesity (23).…”

“…Previous studies have shown that 30–70% patients with stroke are diagnosed with CAOD, which is associated with long-term cardiovascular outcomes even in patients without any definite clinical history of CAOD (5, 6). Computed tomography-based coronary artery calcium (CAC) score, a non-invasive and simple quantitative measure of atherosclerotic burden in the coronary artery, can be used for the prediction of occult coronary artery disease as a surrogate marker for future cardiovascular events (7, 8). Given the association between the risk of CAOD and prevalence of sleep apnea in an otherwise healthy population (9), the atherosclerotic burden on the coronary artery may be dependent on the severity of sleep apnea in patients with stroke in whom sleep apnea is common.…”

Prévalence de la coronaropathie chez les survivants d´accident vasculaire cérébral à Parakou (Bénin) en 2019

“…en Slovaquie en 2012 (71,8%) [ 15 , 16 ]. Par contre, des prévalences plus faibles entre 15 et 40% ont été notées en Tanzanie (Afrique), en Suisse, au Japon et en France [ 2 , 17 - 21 ]. Dans l´étude tanzanienne qui a utilisé l´électrocardiographie comme moyen de dépistage, la faible prévalence retrouvée (23,7%) pourrait s´expliquer par le fait que les séquelles d´infarctus du myocarde étaient le seul critère utilisé pour détecter la coronaropathie [ 2 ].…”

High coronary calcium score and post-procedural CK-MB are noninvasive predictors of coronary stent restenosis

“…12 , 13 Coronary calcification has been examined in many studies as a noninvasive surrogate by which atherosclerosis can be diagnosed and its severity can be assessed. 2 – 7 In addition, other studies have reported that CCS is helpful for the early detection of asymptomatic atherosclerosis. 11 , 14 Many studies have reported that the CCS measured on CT is a significantly predictive factor for the occurrence of asymptomatic and symptomatic CAD.…”

“… 1 – 6 According to a recent meta-analysis, low-dose coronary computerized tomography (CT) showed that CCS values of 0, 1–99, 100–400, 400–999, and ≥1,000, had 1.0, 1.9, 4.3, 7.2, and 10.8 as relative risk ratio of cardiovascular disease, respectively. 1 , 2 The quantification of CCS has been reported to be a more reliable prognostic factor for cardiovascular disease. 7 , 8 Highly calcified lesion was closely related with poor clinical outcomes due to stent underexpansion and edge dissection.…”