Autopsy prevalence of coronary atherosclerosis in patients with fatal stroke
Fernando Gongora-Rivera1, Julien Labreuche, Arturo Jaramillo
1Department of Neuropathology Raymond Escourolle, La Salpêtrière Hospital, France.
Insights
Coronary atherosclerosis and myocardial infarction (MI) are common in stroke patients, with MI often silent. These conditions are more prevalent when cerebral artery atherosclerosis is present.
Area of Science:
- Cardiovascular Pathology
- Neuropathology
- Clinical Autopsy Studies
Background:
- Myocardial infarction (MI) is a major cause of mortality in stroke survivors.
- The prevalence of coronary atherosclerosis in stroke patients remains largely unknown.
- Understanding this link is crucial for managing stroke patient outcomes.
Purpose of the Study:
- To determine the prevalence of coronary atherosclerosis and MI in patients who have died from stroke.
- To compare these prevalences with those in patients with other neurologic diseases.
- To investigate the association between coronary atherosclerosis and cerebral artery atherosclerosis.
Main Methods:
- Utilized an autopsy data bank of 803 consecutive neurologic patients.
- Examined coronary plaques, coronary stenoses (>50%), and pathological evidence of MI.
- Compared findings between stroke patients and those with other neurologic conditions.
Main Results:
- Coronary plaques, stenoses, and MI were significantly more prevalent in stroke patients (72.4%, 37.5%, 40.8%) than in others (26.8%, 10.1%, 12.8%).
- Two-thirds of MI cases were clinically silent, discovered only at autopsy.
- Coronary atherosclerosis and MI were more frequent in stroke patients with concurrent carotid or cerebral artery atherosclerosis.
Conclusions:
- Coronary atherosclerosis and MI are highly prevalent in stroke decedents, irrespective of stroke cause.
- The presence of atherosclerosis in cerebral arteries correlates with increased coronary atherosclerosis and MI.
- These cardiovascular issues are common even in stroke patients without evident cerebral atherosclerosis.
Background And Purpose:
Myocardial infarction (MI) is the leading cause of long-term mortality in patients with stroke, yet the prevalence of coronary atherosclerosis in these individuals is unknown. The objective of the study was to establish the prevalence of coronary atherosclerosis and MI after fatal stroke.
Methods:
Using an autopsy data bank, we studied the prevalence of coronary plaques and coronary stenoses >50% and pathologic evidence of MI in 803 consecutive autopsies of neurologic patients.
Results:
Coronary plaques, coronary stenoses, and MI were present in 72.4%, 37.5%, and 40.8%, respectively, of the 341 patients with stroke and in 26.8%, 10.1%, and 12.8%, respectively, of the 462 patients with other neurologic diseases (P<0.001). Two-thirds of cases of MI were clinically silent and found at autopsy. Compared with other neurologic diseases, and after adjusting for age, gender, and heart weight, the odds ratios (95% confidence intervals) of the presence of coronary plaques, coronary stenosis, and MI in stroke patients were 3.81 (2.66 to 5.46), 2.80 (1.85 to 4.25), and 2.34 (1.58 to 3.46), respectively. The frequency of coronary atherosclerosis and MI was similar between stroke subtypes. The prevalence of coronary plaques, coronary stenosis, and MI was 79.0%, 42.9%, and 46.0%, respectively, in the presence of plaques in any segment of the extracranial and intracranial brain arteries, and 50.8%, 17.9%, and 23.9%, respectively, in the absence of plaques (adjusted P<0.01). Coronary atherosclerosis was also related to the severity of atherosclerosis in any segment of the cerebral arteries (adjusted probability value for linear trend <.005).
Conclusions:
Coronary atherosclerosis and MI are highly prevalent in patients who died from a stroke regardless of the etiology. They are more frequent when atherosclerosis is present in the carotid and cerebral arteries. They are also common in stroke patients with no evidence of carotid or cerebral atherosclerosis.
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