The Frequency and Risk of Preclinical Coronary Artery Disease Detected Using Multichannel Cardiac Computed Tomography in Patients with Ischemic Stroke

Abstract

Background: Atherosclerosis is a systemic disease. Many ischemic stroke patients may have concomitant coronary artery disease (CAD). Detection and treatment of preclinical CAD in stroke patients may improve long-term outcome and survival because CAD is a major cause of death during follow-up in stroke patients. However, association between coronary and cerebral artery atherosclerosis in stroke patients has not fully been investigated. This study aimed at examining the frequency and high-risk groups of CAD in ischemic stroke patients. Methods: Consecutive patients who were admitted due to acute ischemic stroke between July 2006 and June 2010 were prospectively enrolled in this study. A total of 1,304 patients who underwent MSCT coronary angiography and cerebral angiography were included in this study. By using 64-multislice computed tomography coronary angiography, we investigated the frequency of CAD and association between coronary and cerebral artery atherosclerosis in terms of location and burden (severity and extent) in stroke patients. We also sought to identify high-risk groups for CAD among stroke patients. Results: The frequency of significant (≧50%) CAD was 32.3% and the frequency of any degree of CAD was 70.1%. Diabetes mellitus, serum levels of total cholesterol, high-density lipoprotein cholesterol and triglyceride, and significant stenosis of the extracranial carotid, intracranial vertebral and basilar arteries were independently associated with CAD. However, no association was found between CAD and significant stenosis of the anterior, middle and posterior cerebral arteries. The association between CAD and cerebral atherosclerosis was stronger with increased severity and extent of cerebral atherosclerosis. When compared to patients with <2 risk factors and without significant cerebral atherosclerosis, those with multiple (≧2) risk factors and atherosclerosis in both the carotid and the vertebrobasilar arteries had very high risks of CAD [odds ratio (OR) 8.36; 95% confidence interval (CI) 4.15–16.87]. The risk was also high in patients with multiple risk factors and atherosclerosis in either the carotid or the vertebrobasilar artery (OR 4.13; 95% CI 2.62–6.51), and in those with <2 risk factors but atherosclerosis in both the carotid and the vertebrobasilar arteries (OR 3.40; 95% CI 1.22–9.47). Conclusions: A substantial portion of stroke patients had preclinical CAD, and there was a clear relationship between coronary and cerebral artery atherosclerosis in terms of location and burden. The risk of CAD was particularly high in stroke patients with multiple risk factors and atherosclerosis of the carotid and/or vertebrobasilar arteries.

Predictive value of newly defined CHA2DS2-VASc-HSF score for severity of coronary artery disease in ST segment elevation myocardial infarction

“…Also, Sunman et al [21] indicated that age, male gender, dyslipidaemia, and especially family history of premature CAD were associated with severity and extent of non-calcified coronary atherosclerotic plaques as shown by multidetector computed tomographic coronary angiography. Additionally, in a recent study, investigators suggested that a substantial portion of stroke patients had preclinical CAD and there was a clear association between coronary and cerebral artery atherosclerosis in terms of location and burden [22]. The risk of CAD was particularly high in stroke patients with multiple risk factors and atherosclerosis of the carotid and/or vertebrobasilar arteries [23,24].…”

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

“…For the purpose of this study, we used data of women between 55 and 75 years old and of men between 45 and 75 years old. 6,10 Cervicocephalic atherosclerosis and coronary artery stenosis were categorized using the same criteria as those used in the derivation cohort.…”

“…The prevalence of severe (≥50% reduction in diameter) occult coronary artery stenosis has been reported to be between 18% and 38% in patients with stroke or TIA and no previous history of CHD. [4][5][6][7] We recently showed that in these patients traditional vascular risk factors, assessed individually or through the Framingham Risk Score (FRS), and the severity of cervicocephalic atherosclerosis are strongly and independently associated with severe coronary artery stenosis detected by 64-section CT. 4 These associations have been confirmed in other studies. [4][5][6] The aim of this study was to derive and validate a simple prediction score for severe occult coronary artery stenosis in stroke/ TIA patients.…”

Long-Term Mortality in Patients With Stroke of Undetermined Etiology

“…Patients were indicated for heart CT when they had at least one of the following: (1) presence of atherosclerosis in the intracranial or extracranial cerebral artery; (2) presence of ≥2 risk factors for coronary artery disease such as hypertension, diabetes mellitus, dyslipidemia, cigarette smoking, and central obesity; and (3) old age (males older than 45 years, females older than 55 years). 16 Among the consecutive patients who had been registered in the prospective stroke registry, those with transient ischemic attack were excluded. When a patient was admitted more than twice because of recurrent strokes, only data for the first admission were used for this study.…”