Coronary artery disease and cardiac events with asymptomatic and symptomatic cerebrovascular disease
B B Love1, M Grover-McKay, J Biller
1Department of Neurology, University of Iowa College of Medicine, Iowa City.
Insights
Nearly half of patients with cerebrovascular disease showed abnormal thallium-201 tests, indicating a high prevalence of coronary artery disease. Screening for cardiac issues is crucial in these patients to identify those at higher risk for cardiac events.
Area of Science:
- Cardiology
- Neurology
- Diagnostic Imaging
Background:
- Cerebrovascular disease, including asymptomatic carotid stenosis, transient ischemic attacks, and small strokes, is often associated with underlying coronary artery disease.
- Evaluating the cardiac status of patients with cerebrovascular disease is essential for risk stratification and management.
Purpose of the Study:
- To determine the prevalence of coronary artery disease (CAD) in patients presenting with asymptomatic carotid stenosis, transient ischemic attacks (TIAs), or small strokes.
- To assess the occurrence of cardiac events during follow-up in this patient cohort.
Main Methods:
- Prospective study of 60 consecutive patients.
- Utilized thallium-201 scintigraphy (201Tl testing) for cardiac assessment.
- Coronary arteriography was performed as per an established protocol.
Main Results:
- Abnormal 201Tl tests were observed in 47% of patients with asymptomatic carotid stenosis and 43% with TIAs or small strokes.
- One-third of patients with no prior history of CAD had abnormal 201Tl tests.
- Peripheral vascular disease was the only significant risk factor associated with abnormal 201Tl tests (p=0.032).
- Significant coronary artery stenosis (>50%) was found in 14 of 15 patients undergoing arteriography.
- Patients with both reversible 201Tl defects and significant coronary stenosis had a higher risk of cardiac events (29%) compared to those without reversible defects (9%).
Conclusions:
- A substantial proportion of patients with cerebrovascular disease have undiagnosed coronary artery disease.
- Abnormal thallium-201 tests are common in patients with symptomatic or asymptomatic cerebrovascular disease.
- Identifying reversible thallium-201 defects and significant coronary stenosis aids in stratifying patients at higher risk for future cardiac events.
- Screening for cardiac disease is recommended for patients with cerebrovascular disease.
Background And Purpose:
The purpose of this study was to evaluate the prevalence of coronary artery disease and coronary events during follow-up in patients with asymptomatic carotid stenosis, transient ischemic attacks, or small strokes.
Methods:
We prospectively studied 60 consecutive patients with thallium-201 scintigraphy followed by coronary arteriography according to an established protocol.
Results:
The 201Tl testing was abnormal in seven of 15 patients (47%) with asymptomatic carotid stenosis and in 19 of 44 patients (43%) with transient ischemic attacks or small strokes (p greater than 0.05). In 33 patients with no history of coronary artery disease, 11 (33%) had reversible 201Tl defects. In 26 patients with a history of coronary artery disease, 15 (58%) had reversible and/or fixed defects (p = 0.054 compared with patients with no history). A history of peripheral vascular disease was the only risk factor significantly associated with an abnormal 201Tl test (p = 0.032). Coronary artery stenosis of greater than 50% was identified in one or more vessels in 14 of 15 patients undergoing coronary arteriography. Over a mean follow-up period of 311 days, four patients (7%) developed new onset of angina. There were four coronary events among 14 patients (29%) with both a reversible area on the 201Tl and abnormal coronary arteriography. In comparison, there were only four coronary events among 46 patients (9%) without reversible defects on the 201Tl studies (p = 0.055).
Conclusions:
Our study demonstrates that one third of patients with no history of coronary artery disease had an abnormal 201Tl test and that nearly one half of patients with either symptomatic or asymptomatic cerebrovascular disease had abnormal 201Tl tests. Patients with a reversible 201Tl defect and significant stenosis by coronary arteriography were at higher risk for subsequent cardiac events. These findings demonstrate the utility of screening patients with asymptomatic and symptomatic cerebrovascular disease for cardiac disease.
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