Prevalence of symptomatic and asymptomatic coronary artery disease in patients with stroke
Kapil Aggarwal1, Rohit Bhatia1, Gautam Sharma2
1All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India - Department of Neurology.
Insights
Many stroke patients have undiagnosed coronary artery disease (CAD). Identifying and managing this silent CAD in stroke survivors could significantly improve their health outcomes.
Area of Science:
- Cardiology
- Neurology
- Nuclear Medicine
Background:
- Myocardial infarction is a major cause of death in stroke survivors.
- Coronary artery disease (CAD) prevalence in stroke patients requires further investigation.
Purpose of the Study:
- To determine the prevalence of symptomatic and asymptomatic coronary artery disease (CAD) in patients who have experienced a stroke.
Main Methods:
- Eighty-six stroke patients were assessed for cardiovascular risk factors and CAD.
- Myocardial perfusion SPECT (MPS) scans were used to detect CAD in patients without prior diagnosis.
- Coronary angiography was performed for suspected cases.
Main Results:
- Overall, 41.5% of evaluated stroke patients had CAD.
- Among asymptomatic patients, 18.8% had CAD.
- Two of 8 suspected CAD patients had abnormal MPS scans, with one showing triple-vessel disease.
Conclusions:
- A significant proportion of stroke patients have associated coronary artery disease.
- Optimal management of silent CAD in stroke patients may enhance clinical outcomes.
- Further research into screening and management strategies is warranted.
Abstract:
Background. Studies have shown that myocardial infarction is a leading cause of death in patients recovering from stroke or transient ischaemic attacks. We aimed to study the prevalence of symptomatic and asymptomatic coronary artery disease (CAD) in patients with stroke. Methods. Eighty-six patients with stroke were evaluated for risk factors and presence of CAD. Patients without a previous diagnosis of CAD underwent stress-rest gated technetium-99m (Tc99m) tetrofosmin myocardial perfusion SPECT (MPS) scan to estimate the presence or absence of a reversible perfusion deficit. Results. Thirty-three patients (clinically asymptomatic for CAD) did not consent for the MPS scan. Among the remaining 53 patients, 13 patients had been previously diagnosed to have CAD, 8 patients were suspected to have underlying CAD and 32 patients were asymptomatic. Among the patients with suspected CAD, 2 had abnormal MPS scans and one had triple-vessel disease on coronary angiography. Of the asymptomatic patients, 6 had CAD. The overall proportion of CAD among patients with stroke was 41.5% (22/53) and that of asymptomatic CAD 18.8% (6/32). Conclusion. A considerable number of patients with stroke may have associated CAD. An optimal management strategy in stroke patients who have silent CAD may improve clinical outcomes.
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