Prevalence of asymptomatic coronary artery disease in ischemic stroke patients: the PRECORIS study
David Calvet1, Emmanuel Touzé, Olivier Varenne
1Department of Neurology, Centre HospitalierSainte-Anne, Paris Descartes University, Centre de Psychiatrie et Neurosciences INSERM UMR 894, Paris, France.
Insights
Approximately one-fifth of patients experiencing ischemic stroke or transient ischemic attack have significant asymptomatic coronary artery disease (CAD). This prevalence is linked to vascular risk factors and carotid artery stenosis, highlighting the need for comprehensive cardiovascular assessment.
Area of Science:
- Cardiology
- Neurology
- Vascular Medicine
Background:
- Coronary artery disease (CAD) is a major cause of death and disability in patients with ischemic stroke.
- The prevalence of asymptomatic CAD in stroke patients is not well-established, yet it may influence preventative strategies.
- Identifying asymptomatic CAD is crucial for managing stroke patients effectively.
Purpose of the Study:
- To determine the prevalence of significant asymptomatic coronary artery disease (CAD) in patients with ischemic stroke or transient ischemic attack (TIA).
- To investigate the association between asymptomatic CAD and traditional vascular risk factors.
- To explore the relationship between asymptomatic CAD and cervicocephalic atherosclerosis.
Main Methods:
- A study involving 300 patients aged 45-75 with nondisabling, noncardioembolic ischemic stroke or TIA without prior CAD history.
- Utilized 64-section computed tomography coronary angiography to assess CAD severity (>or=50% stenosis).
- Conducted detailed cervicocephalic arterial workup and assessed vascular risk factors, including Framingham Risk Score.
Main Results:
- The prevalence of significant asymptomatic CAD (>or=50% stenosis) was 18% among the studied patients.
- Asymptomatic CAD was independently associated with higher vascular risk scores, excessive alcohol consumption, and ankle-brachial index <0.9.
- A strong correlation was found between asymptomatic CAD and the presence of significant cervicocephalic artery stenosis.
Conclusions:
- Nearly one-fifth of patients with ischemic stroke or TIA exhibit significant asymptomatic coronary artery disease.
- Cervicocephalic artery stenosis is a significant predictor of asymptomatic CAD, alongside traditional vascular risk factors.
- These findings underscore the importance of evaluating coronary atherosclerosis in stroke patients, even in the absence of cardiac symptoms.
Background:
Coronary artery disease (CAD) is a significant cause of morbidity and mortality in stroke patients. Some patients with asymptomatic CAD might benefit from specific prevention, but the prevalence of asymptomatic CAD is not well known. We assessed the prevalence of >or=50% asymptomatic CAD in patients with ischemic stroke or transient ischemic attack and whether the prevalence is related to traditional vascular risk factors and cervicocephalic atherosclerosis.
Methods And Results:
From January 2006 to February 2009, consecutive patients between 45 and 75 years of age with nondisabling, noncardioembolic ischemic stroke or transient ischemic attack and no prior history of CAD were enrolled in the study. All patients had a 64-section computed tomography coronary angiography and a detailed cervicocephalic arterial workup. Risk factors were assessed individually and through the Framingham Risk Score. Among 300 patients included in the study, 274 had computed tomography coronary angiography. The prevalence of >or=50% asymptomatic CAD was 18% (95% confidence interval [CI], 14 to 23; n=50). Asymptomatic CAD was independently associated with traditional risk factors assessed individually and through the Framingham Risk Score (odds ratio [OR], 2.6; 95% CI, 1.0 to 7.6 for a 10-year risk of coronary heart disease of 10% to 19%; and OR, 7.3; 95% CI, 2.8 to 19.1 for a 10 year-risk of coronary heart disease >or=20%), the presence of at least 1 >or=50% cervicocephalic artery stenosis (OR, 4.0; 95% CI, 1.4 to 11.2), excessive alcohol consumption (OR, 3.1; 95% CI 1.3 to 7.3), and ankle brachial index <0.9 (OR, 2.2; 95% CI, 0.9 to 5.2). The prevalence of >or=50% asymptomatic CAD was also related to the extent of cervicocephalic atherosclerosis.
Conclusions:
About one fifth of patients with nondisabling, noncardioembolic ischemic stroke or transient ischemic attack have >or=50% asymptomatic CAD. In addition to vascular risk factors, the presence of >or=50% cervicocephalic artery stenosis is strongly related to >or=50% asymptomatic CAD.
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