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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Incidence of subclinical coronary atherosclerosis in patients with suspected embolic stroke using cardiac computed
Yeonyee E Yoon1, Hyuk-Jae Chang, Iksung Cho
1Division of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, South Korea.
Insights
Subclinical coronary artery disease (CAD) is common in patients with suspected embolic stroke or TIA. Coronary artery calcium scoring (CACS) better identifies significant CAD than current guidelines, improving cardiac testing in this population.
Area of Science:
- Cardiology
- Neurology
- Radiology
Background:
- Subclinical coronary artery disease (CAD) is a potential source of embolism in patients experiencing acute embolic stroke or transient ischemic attack (TIA).
- Conventional risk stratification may not adequately identify all patients with significant CAD in this population.
Purpose of the Study:
- To determine the incidence of subclinical CAD in patients with suspected embolic stroke/TIA using 64-row multi-slice computed tomography (MSCT).
- To assess the association between subclinical CAD and conventional risk factors.
- To evaluate the effectiveness of current guidelines versus coronary artery calcium scoring (CACS) in identifying significant CAD.
Main Methods:
- 175 patients with suspected embolic stroke/TIA underwent 64-row MSCT, including coronary artery calcium scoring (CACS) and coronary CT angiography (CCTA).
- Exclusion criteria included a history of angina, documented CAD, or significant carotid stenosis.
- Atherosclerotic plaques and diameter stenosis (≥50%) were evaluated.
Main Results:
- Atherosclerotic plaques were found in 60% of patients; 21% had ≥50% diameter stenosis on CCTA.
- Patients with and without significant CAD showed similar prevalence of cardiovascular risk factors.
- Current guidelines would miss 17% of patients with significant CAD, whereas CACS would miss only 2%.
Conclusions:
- Subclinical CAD, including ≥50% stenotic disease, is highly prevalent in patients with suspected embolic stroke.
- Current guidelines for cardiac testing have limited value in identifying significant CAD in this population.
- Coronary artery calcium scoring (CACS) is a more effective tool for identifying patients with significant subclinical CAD.
Abstract:
The purpose of this study was to investigate the incidence of subclinical coronary artery disease (CAD) in patients with suspected acute embolic stroke or transient ischemic attack (TIA) using 64-row multi-slice computed tomography (MSCT) and to examine its association with conventional risk stratification. We consecutively enrolled 175 patients (66 ± 13 years, 50% men) suspected to have had embolic stroke/TIA clinically or radiologically, and underwent 64-row MSCT to evaluate for a possible cardiac source of embolism. Both coronary artery calcium scoring (CACS) and coronary CT angiography (CCTA) were concurrently performed based on standard scanning protocols. Patients with a history of angina or documented CAD, and those with significant carotid stenosis were excluded. Atherosclerotic plaques were indentified in 105 (60%) individuals; 37 (21%) had occult CAD of ≥50% diameter stenosis on CCTA. Subjects with and without ≥50% occult CAD on CCTA had similar prevalence of cardiovascular risk factors. Thirty out of 175 (17%) individuals with ≥50% occult CAD would have missed further cardiac testing based on the American Heart association and the American Stroke Association guideline. However, these numbers would be reduced to 2% (4/175) using CACS. In logistic regression analysis, only CACS independently predicted the presence ≥50% occult CAD evidenced by CCTA. Subclinical CAD, including ≥50% stenotic disease, is highly prevalent in patients who had suffered a suspected embolic stroke. The current guideline for further cardiac testing may have limited value to identify patients with ≥50% CAD in this patient population, which can be improved by adopting CACS.
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