Predicting Asymptomatic Coronary Artery Diseasein Patients With Ischemic Stroke and Transient Ischemic Attack

Calvet, D.; Song, Dongbeom; Yoo, Joonsang; Turc, Guillaume; Sablayrolles, Jean‐Louis; Choi, Byoung Wook; Heo, Ji Hoe; Mas, Jean Louis

doi:10.1161/strokeaha.113.003414

Cited by 27 publications

(26 citation statements)

References 28 publications

(31 reference statements)

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“…The identification of severe occult coronary artery stenosis may help to improve prevention of cardiac events in stroke/TIA patients. The prevalence of severe (≥50% reduction in diameter) occult coronary artery stenosis has been reported to be significantly high, between 18% and 38% in patients with stroke or TIA and no previous history of coronary heart disease and predictable …”

Section: Introductionmentioning

confidence: 99%

“…Using these simple predictive factors, we derived and validated the 5‐point PRECORIS score that was found to have a good predictive ability to identify stroke patients with severe (≥50%) occult coronary artery stenosis in a stroke/TIA population. However, despite its good predictive ability, 50% of patients with a high PRECORIS score (≥4) have no severe occult coronary stenosis . Thus, identification of such patients at high risk of occult coronary artery stenosis still needs to be improved.…”

Section: Introductionmentioning

confidence: 99%

“…The prevalence of severe (≥50% reduction in diameter) occult coronary artery stenosis has been reported to be significantly high, between 18% and 38% in patients with stroke or TIA and no previous history of coronary heart disease and predictable. [3][4][5][6][7][8] We previously showed in a population with stroke/TIA that in addition to traditional risk factors, the severity of cervicocephalic artery stenosis was strongly associated with severe occult coronary stenosis. Using these simple predictive factors, we derived and validated the 5-point PRECORIS score that was found to have a good predictive ability to identify stroke patients with severe (≥50%) occult coronary artery stenosis in a stroke/TIA population.…”

mentioning

confidence: 99%

“…However, despite its good predictive ability, 50% of patients with a high PRECORIS score (≥4) have no severe occult coronary stenosis. 7 Thus, identification of such patients at high risk of occult coronary artery stenosis still needs to be improved. In large prospective studies, coronary artery calcium score (CACS), a fast and simple computed tomography (CT) measurement of the amount of calcium in the walls of coronary arteries, was shown to be associated with the risk of future cardiovascular events.…”

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confidence: 99%

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

Beigneux

Sablayrolles

Varenne

et al. 2016

JAHA

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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.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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

Beigneux

Sablayrolles

Varenne

et al. 2016

JAHA

Self Cite

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“…Although there is evidence that patients suffering a transient ischemic attack (TIA) or ischemic stroke (IS) are at high risk of coronary artery disease (CAD),1, 2, 3, 4, 5 current guidelines for prevention of coronary events in high‐risk individuals do not include stroke patients 6, 7. A writing group committee suggested the inclusion of large atherosclerosis IS, while other subtypes of IS are thought to carry a lower risk of CAD 8.…”

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confidence: 99%

Long‐Term Risk of Myocardial Infarction Compared to Recurrent Stroke After Transient Ischemic Attack and Ischemic Stroke: Systematic Review and Meta‐Analysis

Boulanger

Béjot

Rothwell

et al. 2018

JAHA

120

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BackgroundUncertainties remain about the current risk of myocardial infarction (MI) after ischemic stroke or transient ischemic attack.Methods and ResultsWe undertook a systematic review to estimate the long‐term risk of MI, compared to recurrent stroke, with temporal trends in ischemic stroke/transient ischemic attack patients. Annual risks and 95% confidence intervals (95% CI) of MI and recurrent stroke were estimated using random‐effect meta‐analyses. We calculated incidence ratios of MI/recurrent stroke, for fatal and nonfatal events, using similar analyses. Rate ratios for MI in patients with potential risk factors compared to those without were calculated using Poisson regression.A total of 58 studies (131 299 patients) with a mean (range) follow‐up of 3.5 (1.0‐10.0) years were included. The risk of MI was 1.67%/y (95% CI 1.36‐1.98, P het<0.001 for heterogeneity) and decreased over time (P int=0.021); 96% of the heterogeneity between studies was explained by study design, study period, follow‐up duration, mean age, proportion of patients on antithrombotic therapy, and incident versus combined ischemic stroke/transient ischemic attack. The risk of recurrent stroke was 4.26%/y (95% CI 3.43‐5.09, P het<0.001), with no change over time (P int=0.63). The risk of fatal MI was half the risk of recurrent strokes ending in fatality (incidence ratio=0.51, 95% CI 0.14‐0.89, P het=0.58). The risk of nonfatal MI was 75% smaller than the risk of recurrent nonfatal stroke (incidence ratio=0.25, 95%CI 0.02‐0.50, P het=0.68). Male sex, hypertension, coronary and peripheral artery diseases were associated with a doubled risk of MI.ConclusionsAfter ischemic stroke/transient ischemic attack, the risk of MI is currently <2%/y, and recurrent stroke is a more common cause of death than MI.

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Effect of prior stroke on long‐term outcomes of percutaneous coronary interventions in Chinese patients: A large single‐center study

Song

Jiang

et al. 2018

Cathet Cardio Intervent

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Objectives: To evaluate the effect of prior stroke on long-term outcomes in patients undergoing percutaneous coronary interventions (PCI).Background: Patients with coronary heart disease (CHD) and prior stroke history have more serious clinical and angiographic conditions, which make the choice of treatment strategy complex.Methods: A total of 10,724 consecutive patients who underwent PCI from January 2013 to December 2013 were enrolled. 2-Year clinical outcomes between patients with prior stroke (n = 1150) and those with no prior stroke (n =9574) were compared.

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Predicting Asymptomatic Coronary Artery Diseasein Patients With Ischemic Stroke and Transient Ischemic Attack

Cited by 27 publications

References 28 publications

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

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

Long‐Term Risk of Myocardial Infarction Compared to Recurrent Stroke After Transient Ischemic Attack and Ischemic Stroke: Systematic Review and Meta‐Analysis

Effect of prior stroke on long‐term outcomes of percutaneous coronary interventions in Chinese patients: A large single‐center study

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