Coronary angiography in acute ischemic stroke patients: frequency and determinants of pathological findings in a
Simon Litmeier1,2,3, Thomas R Meinel4, Regina von Rennenberg5,6,7
1Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany. simon.litmeier@charite.de.
Insights
Coronary angiography in acute stroke patients with myocardial injury can help identify coronary artery disease (CAD). Absence of obstructive CAD is linked to specific clinical factors, aiding decision-making for these high-risk patients.
Area of Science:
- Cardiology
- Neurology
- Interventional Cardiology
Background:
- Myocardial injury in acute stroke patients indicates poor prognosis.
- Coronary angiography (CAG) is standard for diagnosing obstructive coronary artery disease (CAD).
- Risk-benefit assessment of CAG is complex due to increased bleeding risk in stroke patients.
Purpose of the Study:
- To analyze the frequency of pathological findings in CAG among acute ischemic stroke patients.
- To identify clinical factors associated with the absence of obstructive CAD in this population.
Main Methods:
- Retrospective analysis of CAG indications and findings in 139 acute ischemic stroke patients (2011-2018).
- Logistic regression used to identify variables associated with absence of obstructive CAD (stenosis ≥50%).
Main Results:
- CAG was performed for suspected acute coronary syndrome (N=114) or pre-cardiac surgery planning (N=25).
- Acute coronary stenting occurred in 51 patients.
- No obstructive CAD was found in 27/114 patients with suspected acute coronary syndrome.
- Absence of obstructive CAD correlated with insular cortex lesions, no acute coronary syndrome symptoms, fewer than three cardiovascular risk factors, younger age, and normal wall motion.
Conclusions:
- Specific clinical variables can suggest the absence of CAD in acute stroke patients with myocardial injury.
- These findings may assist in clinical decision-making regarding CAG in this patient group.
Background:
Myocardial injury as indicated by cardiac troponin elevation is associated with poor prognosis in acute stroke patients. Coronary angiography (CAG) is the diagnostic gold-standard to rule-out underlying obstructive coronary artery disease (CAD) in these patients. However, weighing risks and benefits of coronary angiography (CAG) against each other is particularly challenging, because stroke patients undergoing CAG may have a higher risk for secondary intracranial bleeding. Current guidelines remain vague. Thus, the aim of this study was to analyze frequency of pathological findings of CAG and associated clinical factors.
Methods:
We analyzed indications and frequency of CAG performed in acute ischemic stroke patients in clinical routine in two European tertiary care hospitals from 2011 to 2018. All data were obtained retrospectively. Multiple logistic regression analyses were performed to identify variables associated with absence of obstructive coronary artery disease defined as presence of at least one coronary vessel stenosis ≥ 50%.
Results:
A total of 139 AIS patients underwent CAG. Frequent indications for CAG were suspected acute coronary syndrome (N = 114) or scheduled cardiac surgery (N = 25). Acute coronary stenting was applied in 51/139 patients. Among patients with suspected acute coronary syndrome, no obstructive CAD was found in 27/114 patients. Absence of obstructive CAD was associated with insular cortex lesions, no clinical symptoms for ACS, less than three cardiovascular risk factors, younger age and normal wall motion.
Conclusion:
Several variables suggest absence of CAD in AIS patients and may help in clinical decision making in stroke patients with myocardial injury.
More Related Videos
04:40Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
09:36A Magnetic Resonance Imaging-based Computational Protocol for Analysis of Plaque Morphology and Hemodynamics in Patients with Carotid Artery Stenosis
Published on: August 12, 2025
Related Concept Videos
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:27Coronary Artery Disease V: Interprofessional Care
01:30Acute Coronary Syndrome I: Introduction
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:27Atherosclerosis II: Clinical Manifestations and Diagnostic Tests