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Published on: January 28, 2020
Coronary artery disease and risk of adverse cardiac events and stroke
Kevin Kris Warnakula Olesen1,2, Morten Madsen2, Gregory Y H Lip3
1Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Insights
Patients with coronary artery disease face higher risks of death and myocardial infarction (MI). This study shows that the extent of coronary artery disease also increases the long-term risk of ischaemic stroke.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- Patients with acute myocardial infarction (MI) have an elevated risk of ischaemic stroke.
- Previous MI is a key factor in assessing ischaemic stroke risk.
- Limited data exists on the link between coronary artery disease (CAD) severity and long-term ischaemic stroke risk.
Purpose of the Study:
- To investigate the association between the severity and extent of coronary artery disease (CAD) and the long-term risk of ischaemic stroke.
- To evaluate the incremental risk of adverse cardiovascular and cerebrovascular events based on CAD extent.
Main Methods:
- A cohort study analyzed coronary angiographies from western Denmark (2003-2012).
- Patients were categorized by the number of vessels with obstructive CAD (≥50% lumen narrowing): zero-, one-, two-, three-vessel disease, and diffuse disease.
- Follow-up was for a maximum of 7 years, assessing all-cause death, cardiac death, MI, and ischaemic stroke.
Main Results:
- The study included 78,195 patients with varying degrees of CAD.
- Increasing severity of obstructive CAD correlated with a higher risk of all-cause death, cardiac death, MI, and ischaemic stroke.
- Diffuse CAD also showed an increased risk profile compared to zero-vessel disease.
Conclusions:
- The presence and extent of coronary artery disease are linked to an increased risk of death, cardiac death, and myocardial infarction (MI).
- Importantly, CAD severity also incrementally increases the risk of ischaemic stroke over a 7-year period.
Background:
Patients with acute myocardial infarction are at increased risk of ischaemic stroke. Previous myocardial infarction is an important part of risk assessment for ischaemic stroke. However, there is a lack of information regarding the association between the severity and extent of coronary artery disease and long-term risk of ischaemic stroke.
Materials And Methods:
A cohort study of coronary angiographies performed in western Denmark from 1 January 2003 to 31 December 2012. Patients were stratified according to the number of vessels affected by obstructive coronary artery disease (lumen narrowing ≥50%) at the time of angiography: zero-, one-, two- or three-vessel disease and diffuse vessel disease. We followed patients for a maximum of 7 years. Endpoints were all-cause death, cardiac death, myocardial infarction and ischaemic stroke. Cumulative risks and crude and adjusted rate ratios were estimated.
Results:
The study population included 78 195 patients. Of these, 32 061 (41·0%) had zero-vessel disease, 6205 (7·9%) had diffuse vessel disease, 20 202 (25·8%) had one-vessel disease, 10 675 (13·7%) had two-vessel disease, and 9038 (11·6%) had three-vessel disease. Median follow-up was 3·6 years (interquartile range 1·7-6·0 years). Increasing severity of obstructive coronary artery disease was associated with an increasing risk of all-cause death, cardiac death, myocardial infarction (MI) and ischaemic stroke during follow-up.
Conclusions:
The presence and extent of coronary artery disease was associated with an incremental risk of not only death, cardiac death, myocardial infarction, but also ischaemic stroke over a 7-year period.
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