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Poor long-term outcomes in stroke patients with asymptomatic coronary artery disease in heart CT

Joonsang Yoo1, Dongbeom Song2, Jang-Hyun Baek3

  • 1Department of Neurology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, Republic of Korea; Department of Neurology, Keimyung University College of Medicine, 56 Dalseong-ro, Jung-gu, Daegu, Republic of Korea.

Atherosclerosis
|August 22, 2017
PubMed

Insights

Asymptomatic coronary artery disease (CAD) in stroke patients, detected by multi-detector coronary computed tomography (MDCT), significantly increases the risk of major adverse cardiovascular events (MACE). Early detection of CAD in stroke patients is crucial for predicting vascular outcomes.

Area of Science:

  • Cardiology
  • Neurology
  • Radiology

Background:

  • Stroke patients face a high risk of ischemic heart disease.
  • Limited data exists on coronary event risk in stroke patients with asymptomatic coronary artery disease (CAD).
  • Multi-detector coronary computed tomography (MDCT) is used to diagnose CAD.

Purpose of the Study:

  • To investigate the long-term vascular outcomes in ischemic stroke patients with asymptomatic CAD.
  • To assess the predictive value of MDCT-diagnosed asymptomatic CAD for major adverse cardiovascular events (MACE).

Main Methods:

  • Retrospective analysis of a prospective cohort of ischemic stroke patients without prior CAD symptoms or history.
  • MDCT was used to identify and quantify CAD.
  • Long-term follow-up for MACE (cardiovascular mortality, ischemic stroke, myocardial infarction, unstable angina, urgent coronary revascularization) and composite outcomes.

Main Results:

  • Among 1893 patients, 71.3% had CAD, and 34.5% had significant CAD (≥50% stenosis).
  • MACE occurred in 12.2% of patients over a median of 4.4 years.
  • The risk of MACE increased with the extent of CAD, with hazard ratios for significant CAD ranging from 2.22 to 2.91.
  • MDCT diagnosis of asymptomatic CAD significantly improved MACE prediction.

Conclusions:

  • Asymptomatic CAD identified by MDCT is linked to a higher risk of vascular events and death in acute stroke patients.
  • MDCT plays a vital role in risk stratification for cardiovascular events in stroke patients.
Abstract

Keywords:
Coronary artery diseaseIschemic strokeMajor adverse cardiac eventMortalityMultidetector computerized tomography

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