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Predicting asymptomatic coronary artery disease in patients with ischemic stroke and transient ischemic attack: the
David Calvet1, Dongbeom Song, Joonsang Yoo
1From Paris Descartes University, Centre de Psychiatrie et Neurosciences INSERM UMR 894, Paris, France (D.C., G.T., J.-L.M.); Department of Neurology, Centre Hospitalier Sainte-Anne, Paris, France (D.C., G.T., J.-L.M.); Departments of Neurology (D.S., J.Y., J.H.H.) and Radiology (B.W.C.), Yonsei University College of Medicine, Seoul, Korea; and Department of Radiology, Centre Cardiolique du Nord, Saint-Denis, France (J.-L.S.).
Insights
A new PRECORIS score helps identify stroke patients with severe coronary artery stenosis, improving secondary prevention. This simple score aids in predicting occult coronary artery disease in at-risk individuals.
Area of Science:
- Cardiology
- Neurology
- Medical Diagnostics
Background:
- Occult coronary artery stenosis is a risk factor for secondary stroke.
- Early identification is crucial for effective secondary stroke prevention strategies.
Purpose of the Study:
- To develop and validate a simple scoring system to predict severe occult coronary artery stenosis in patients with ischemic stroke or transient ischemic attack.
- To aid in the secondary prevention of cardiovascular events in this patient population.
Main Methods:
- A predictive score (PRECORIS) was derived from a French cohort (n=300) and validated in a Korean cohort (n=1602).
- Severe coronary artery stenosis was defined as ≥50% narrowing detected by CT coronary angiography.
- The score incorporated Framingham Risk Score predictions and cervicocephalic artery stenosis severity.
Main Results:
- The PRECORIS score demonstrated predictive ability for occult ≥50% coronary artery stenosis in both derivation (C-statistic=0.77) and validation (C-statistic=0.66) cohorts.
- The score showed higher predictive accuracy for severe left main trunk or 3-vessel disease.
- Prevalence of severe coronary artery stenosis increased with higher PRECORIS scores, reaching up to 49.8% in the validation cohort.
Conclusions:
- The PRECORIS score effectively identifies stroke patients with a high prevalence of occult severe coronary artery stenosis.
- This tool can assist clinicians in risk stratification and guiding secondary prevention efforts.
Background And Purpose:
Identifying occult coronary artery stenosis may improve secondary prevention of stroke patients. The aim of this study was to derive and validate a simple score to predict severe occult coronary artery stenosis in stroke patients.
Methods:
We derived a score from a French hospital-based cohort of consecutive patients (n=300) who had an ischemic stroke or a transient ischemic attack and no previous history of coronary heart disease (Predicting Asymptomatic Coronary Artery Disease in Patients With Ischemic Stroke and Transient Ischemic Attack [PRECORIS] score) and validated the score in a similar Korean cohort (n=1602). In both cohorts, severe coronary artery stenosis was defined by the presence of at least 1≥50% coronary artery stenosis as detected by 64-section CT coronary angiography.
Results:
A 5-point score (Framingham Risk Score-predicted 10-year coronary heart disease risk [≥20%=3; 10-19%=1; <10%=0] and cervicocephalic artery stenosis [≥50%=2; <50%=1; none=0]) was predictive of occult≥50% coronary artery stenosis risk in the derivation cohort (C-statistic=0.77 [0.70-0.84]) and in the validation cohort (C-statistic=0.66 [0.63-0.68]). The predictive ability of the score was even stronger when only ≥50% left main trunk disease or 3-vessel disease were considered (C-statistic=0.83 [0.74-0.92] and 0.70 [0.66-0.74] in derivation and validation cohorts, respectively). The prevalence of occult≥50% coronary artery stenosis and ≥50% left main trunk or 3-vessel disease increased gradually with the PRECORIS score, reaching 44.2% and 13.5% in derivation cohort and 49.8% and 12.8% in validation cohort in patients with a PRECORIS score≥4.
Conclusions:
The PRECORIS score can identify a population of stroke or transient ischemic attack patients with a high prevalence of occult severe coronary artery stenosis.
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