Prevalence of coronary atherosclerosis in patients with cerebral infarction
Pierre Amarenco1, Philippa C Lavallée, Julien Labreuche
1INSERM U-698 and Paris-Diderot University, Paris, France. pierre.amarenco@bch.aphp.fr
Insights
A high prevalence of silent coronary artery disease exists in stroke patients without prior heart disease history. Atherosclerosis in carotid and femoral arteries strongly predicts coronary artery disease in these individuals.
Area of Science:
- Cardiology
- Neurology
- Vascular Medicine
Background:
- Coronary heart disease and stroke share overlapping risk factors.
- The prevalence of coronary artery disease (CAD) in nonfatal cerebral infarction patients with no prior CAD history is not well-defined.
Purpose of the Study:
- To determine the prevalence of coronary artery disease in patients with acute cerebral infarction and no known history of coronary heart disease.
- To investigate the association between atherosclerosis in other arterial territories and the presence of coronary artery disease.
Main Methods:
- 405 patients with acute cerebral infarction underwent ultrasound of major arteries.
- 315 patients without known CAD underwent coronary angiography 8 days post-stroke.
- Carotid and femoral artery plaque presence was assessed for correlation with coronary findings.
Main Results:
- 61.9% of patients had coronary plaques; 25.7% had stenoses ≥ 50%.
- Coronary plaque prevalence increased with plaque in carotid and/or femoral arteries.
- Plaque in both carotid and femoral arteries predicted coronary plaque with 84% positive predictive value.
Conclusions:
- Silent coronary artery disease is highly prevalent in stroke patients without known CAD.
- Evidence of atherosclerosis in peripheral arteries (carotid, femoral) significantly increases the likelihood of concurrent coronary artery disease.
Background And Purpose:
there is an overlap between stroke and coronary heart disease, but the exact prevalence of coronary artery disease in patients with nonfatal cerebral infarction is unclear, particularly when there is no known history of coronary heart disease.
Methods:
we consecutively enrolled 405 patients presenting with acute cerebral infarction documented by neuroimaging who underwent carotid and femoral artery, thoracic, and abdominal aorta ultrasound examinations. Of the 342 patients with no known coronary heart disease, 315 underwent coronary angiography a median of 8 days (interquartile range, 6-11) after stroke onset.
Results:
coronary plaques on angiography, regardless of stenosis severity, were present in 61.9% of patients (95% confidence interval [CI], 56.5-67.3) and coronary stenoses ≥ 50% were found in 25.7% (95% CI, 20.9-30.5). The overall prevalence of coronary plaque increased with the number of arterial territories (carotid or femoral arteries) involved, with an adjusted odds ratio of coronary artery disease of 1.25 (95% CI, 0.58-2.71) for presence of plaque in 1 territory, and 4.31 (95% CI, 1.92-9.68) for presence of plaque in both territories, compared with no plaque in either territory. The presence of plaque in both femoral and carotid arteries had an age- and sex-adjusted positive predictive value of 84% for presence of coronary plaque and a negative predictive value of 44%.
Conclusions:
there is a high burden of silent coronary artery disease in patients with nonfatal cerebral infarction and no known coronary heart disease, even in the absence of systemic atherosclerosis. The prevalence is even higher in patients with evidence of carotid and/or femoral plaque.
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